Tumoral necrosis factor α plays a central role in both the inflammatory response and that of the immune system. Thus, its blockade with the so-called anti TNF drugs / agents has turned into the most important tool in the management of a variety of disorders, such as rheumatoid arthritis, spondyloarthropatties, inflammatory bowel disease, and psoriasis.
Currently, five anti-TNF drugs / agents are commercially available: infliximab, etanercept, adalimumab, certolizumab pegol, and golimumab. These five TNF-blocking agents are currently licensed for the treatment of a variety of disorders, namely, RA (INX, ETP, ADB, CZP, and GLB), juvenile idiopathic arthritis (JIA) (ETP and ADB), ankylosing spondylitis (AS) (INX, ETP, ADB, and GLB), psoriasis (INX, ETP, and ADB), psoriatic arthritis (PsA) (INX, ETP, ADB, and GLB), Crohn's disease (CD) (INX, ADB, and CZP) and ulcerative colitis (UC) (INX and ADB). Nonetheless, the anti TNF drugs / agents are being used in an increasing number of autoimmune disorders, in those cases which are severe and resistant, or intolerant, to standard immunosuppressive therapies.
To date, all of the studies of anti-TNF therapy are of infliximab and are mixed in their reports of the risk of post-operative complications associated with it. The studies are limited by small numbers of patients, disparate comparison groups, different definitions of measured outcomes and varying timeframes of drug exposure and follow-up. Larger controlled studies, with well-defined standardized criteria, are needed to clarify this issue. In the meantime, physicians must be aware of these potential risks so that prudent decisions about patient selection and timing of interventions can be made.