Does safety make a difference in selecting the right TNF antagonist.docVIP

Arthritis Research Therapy Vol 6 Suppl 2 Fleischmann and Yocum Review Does safety make a difference in selecting the right TNF antagonist? Roy Fleischmann1 and David Yocum2 1University of Texas Southwestern Medical Center, Dallas, TX, USA 2University of Arizona Arthritis Center, Tucson, AZ, USA Corresponding author: Roy Fleischmann (e-mail: royfleischmann@) Received: 17 Jul 2003 Accepted: 6 Aug 2003 Published: 21 Jun 2004 Arthritis Res Ther 2004, 6(Suppl 2):S12-S18 (DOI 10.1186/ar995) ? 2004 BioMed Central Ltd (Print ISSN 1478-6354; Online ISSN 1478-6362) Abstract Tumor necrosis factor (TNF) antagonists are biologic response modifiers that have significantly improved the outcomes in patients with rheumatoid arthritis (RA). At this report, safety data were collected on approximately 271,000 patients administered infliximab (as of February 2002), 121,000 patients administered etanercept (as of December 2001), and on 2400 patients who received adalimumab in trials in connection with the regulatory approval process (approval granted December 2002 in the US and September 2003 in European Union). Infliximab and etanercept have predictable and manageable safety profiles, and preliminary data suggest that the profile of adalimumab is comparable. Safety issues involving the anti-TNF agents as a class include the risk of injection-site reactions or infusion-related reactions, infection (for example, serious, opportunistic, or tubercular), malignancy, autoimmunity, and demyelinating and neurologic disorders. Injection-site and infusion- related reactions are most often easily managed and rarely lead to discontinuation of therapy. Infections can be minimized or prevented by screening and careful monitoring and follow-up; most infections respond to appropriate medical treatment. More studies are needed to evaluate the occurrence of malignancies in patients wi