Department of Medicine, University of Patras, 26504, Patras, Greece.
QJM. 2010 Dec;103(12):917-28. doi: 10.1093/qjmed/hcq152. Epub 2010 Aug 27.
Tumour necrosis factor alpha (TNF-α) is a key molecule of the inflammatory response and data derived from studies in experimental animal models and humans suggest that TNF-α may be implicated in the pathogenesis of various autoimmune and non-infectious inflammatory conditions. Over the past decade pharmaceutical agents directed against TNF-α (infliximab, adalimumab and etanercept) have been widely and successfully employed for the management of rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriasis, psoriatic arthritis, juvenile idiopathic arthritis and inflammatory bowel disease, whereas two novel anti-TNF-α agents, golimumab and certolimumab pegol, recently entered the market for the treatment of RA, AS, Crohn's disease and psoriasis. Encouraged by the positive results obtained from the use of TNF-α antagonists in terms of efficacy and safety and due to the increasingly accumulating evidence regarding the implication of TNF-α in the pathogenesis of numerous disorders, anti-TNF-α agents have been considered for the management of diseases other than the ones they were initially approved for. Although in the case of multiple sclerosis and chronic heart failure the outcome from the administration of TNF-α blockers had been less than favourable, in other cases of non-infectious inflammatory conditions the response to TNF-α inhibition had been fairly beneficial. More specifically, according to well-documented clinical trials, anti-TNF-α agents exhibited favourable results in Behçet's disease, non-infectious ocular inflammation, pyoderma gangrenosum and hidradenitis suppurativa. In this review we discuss the successful outcomes as well as the prospects for the future from the off-label use of TNF-α antagonists.
肿瘤坏死因子-α（TNF-α）是炎症反应的关键分子，来自实验动物模型和人类的研究数据表明，TNF-α可能与各种自身免疫和非传染性炎症疾病的发病机制有关。在过去的十年中，针对 TNF-α 的药物（英夫利昔单抗、阿达木单抗和依那西普）已被广泛成功地用于治疗类风湿关节炎（RA）、强直性脊柱炎（AS）、银屑病、银屑病关节炎、幼年特发性关节炎和炎症性肠病，而两种新型抗 TNF-α 药物，戈利木单抗和培塞利珠单抗，最近也被用于治疗 RA、AS、克罗恩病和银屑病。由于 TNF-α 拮抗剂在疗效和安全性方面取得了积极的结果，并且由于 TNF-α 在许多疾病发病机制中的作用的证据不断积累，抗 TNF-α 药物已被考虑用于治疗初始批准适应证以外的疾病。虽然在多发性硬化症和慢性心力衰竭中，TNF-α 阻滞剂的治疗结果并不理想，但在其他非传染性炎症疾病中，TNF-α 抑制的反应相当有益。具体来说，根据有充分文献记录的临床试验，抗 TNF-α 药物在白塞病、非传染性眼部炎症、坏疽性脓皮病和化脓性汗腺炎中显示出良好的疗效。在这篇综述中，我们讨论了 TNF-α 拮抗剂的标签外使用的成功结果和未来前景。
