Anti-TNF-α therapy in the treatment of rheumatoid arthritis

The etiology of rheumatoid arthritis (RA) is not known and its pathogenesis is complicated. However, tumor necrosis factor-α (TNF-α) has an important role in the pathogenesis of RA. There are two anti-TNF biological drugs, anti-TNF monoclonal antibodies (infliximab) and TNF receptors (etanercept), that we are able to use for RA patients in Japan. In this article, we introduced these anti-TNF biologies and their clinical efficacy from our experiences in patients with RA. Anti-TNF biologies improved the C reactive protein (CRP) levels and the disease activity score (DAS) 28. TNF-α and interleukin-6 (IL-6) levels were decreased in the course of infliximab therapy. In contrast, TNF-α levels were increased in etanercept therapy. Although anti-TNF biologies appear to have good efficacy for RA patients, careful attention must be paid to possible infections, such as tuberculosis, bronchitis, and Pneumocystis jiroveci. Another biologies for RA treatment will be approved in Japan in near future. We must provide the proper treatment using biologies in RA patients.