A comprehensive review and evaluation of the side effects of the tumor necrosis factor alpha blockers etanercept, infliximab and adalimumab

  title={A comprehensive review and evaluation of the side effects of the tumor necrosis factor alpha blockers etanercept, infliximab and adalimumab},
  author={Noah S. Scheinfeld},
  journal={Journal of Dermatological Treatment},
  pages={280 - 294}
  • N. Scheinfeld
  • Published 1 September 2004
  • Medicine
  • Journal of Dermatological Treatment
For more than 5 years, infliximab and etanercept have been utilized to treat rheumatoid arthritis and Crohn's disease. There is therefore much post‐approval data on their side effects. A variety of Medline searches were done at the beginning of June 2004 using the terms ‘etanercept’, ‘infliximab’ and ‘adalimumab’ and the words ‘lymphoma’, ‘infection’, ‘congestive heart failure’, ‘demyelinating disease’, ‘lupus’, ‘antibodies’, ‘injection site reaction’, ‘systemic’, ‘side effects' and ‘skin… 
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Selective TNF-α inhibitor-induced injection site reactions
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Adalimumab causing vasculitis
A 44-year-old Indian woman who had recently been commenced on adalimumab for rheumatoid arthritis and had had no previous episodes of vasculitis is reported, which clearly favours the diagnosis of an adverse cutaneous drug eruption to this agent.
Adalimumab: a review of side effects
Adalimumab is a useful medication which can be safely used if its side effects are recognised, and in patients with any of the foregoing problems, its use should be extremely carefully considered.
Heart failure as an adverse effect of infliximab for Crohn's disease: A case report and review of the literature
This reported case supports the need to investigate risk factors for HF in inflammatory bowel disease patients and to consider the risk-benefit of introducing infliximab therapy in such patients presenting with HF risk factors.
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Short-term data suggested that these biologic agents can delay joint disease progression and evidence to support their use in the treatment of PsA is convincing, and infliximab appeared to be most effective across all outcomes of joint and skin disease.


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The known predisposition of patients with RA and CD to lymphoma, the known excess of lymphoma in other Immunosuppressed populations, and the known immunosuppressive effects of the anti-TNF drugs provide a biologic basis for concern and justification for the initiation of additional epidemiologic studies to formally evaluate this possible association.
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Although anti-TNFα drugs represent an important advance in RA treatment, postmarketing reports of serious infections, as well as other adverse events, highlight the need for continued post marketing vigilance with the use of these agents.
A lupus-like syndrome associated with infliximab therapy.
Findings support recent evidence identifying TNF-alpha as an inhibitor of autoantibody formation and infliximab therapy may cause a lupus-like syndrome that is reversible upon discontinuing this agent.
New onset systemic lupus erythematosus in a patient receiving etanercept for rheumatoid arthritis
The management of severe rheumatoid arthritis (RA) has been revolutionised by the introduction of the biological agents infliximab (Remicade—a chimeric anti-tumour necrosis factor (TNF) α antibody),
Skin reaction to adalimumab.
The case of an erythema multiforme-like skin reaction to treatment with the monoclonal anti-TNFalpha antibody adalimumab in a patient with rheumatoid arthritis is reported, and it is believed the reaction is most likely attributable to adAlimumab.
Infliximab Treatment of Rheumatoid Arthritis and Crohn's Disease
Infliximab is an effective new agent for the treatment of Crohn's disease and RA and its apparent unique mechanism of action makes infliximab an important addition to therapy.
Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent
Infliximab is a humanized antibody against tumor necrosis factor α (TNF-α) that is used in the treatment of Crohn's disease and rheumatoid arthritis but there is no direct evidence of a protective role of TNF- α in patients with tuberculosis.
Acute leukemia after infliximab therapy
Concern exists regarding the ability of TNF- antagonist in immune response to increase the risk for malignancy, among other severe adverse effects of infl iximab.
Drug-induced lupus following treatment with infliximab in rheumatoid arthritis
A 69-year-old female with a 5 year history of RA, who was successfully treated with low-dose methotrexate (MTX) and infliximab and with discontinuation of treatment and therapy with oral prednisone, lupus resolved within 8 weeks.
Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent.
Active tuberculosis may develop soon after the initiation of treatment with infliximab, and physicians should screen patients for latent tuberculosis infection or disease before prescribing the drug.