Tumor necrosis factor inactivation in the management of rheumatoid arthritis

Biologic agents that target molecules and cells involved in chronic inflammation are coming into clinical use for the treatment of rheumatoid arthritis (RA). New agents block the action of cytokines, which play a key role in the pathogenesis of RA. Among the many cytokines involved in RA, tumor necrosis factor (TNF) is believed to be dominant. Two agents for neutralizing TNF are now available. One is a recombinant molecule, etanercept, which is derived from a naturally occurring TNF antagonist, one of the soluble human TNF receptors. The other, infliximab, is a chimeric (human-mouse) monoclonal antibody against human TNF. These biologic agents have been shown to relieve symptoms in patients with refractory RA. If tolerance of these and other anticipated anticytokine agents continues over the long term, treatment for patients with RA will become safer and more effective.