Inhibition of the TNF-pathway: use of infliximab and etanercept as remission-inducing agents in cases of therapy-resistant chronic inflammatory disorders.
OBJECTIVE
To examine the potential of the two tumour necrosis factor (TNF) inhibitors infliximab and etanercept as remission-inducing agents in chronic therapy-resistant inflammatory disorders of immune or non-immune pathogenesis.


METHODS
14 patients with adult Still's disease/macrophage activation syndrome (4), Wegener's disease (3), Behçet's disease (3), keratoscleritis (1), lymphomatous tracheo-bronchitis (1) Cogan's syndrome (1), and rapidly destructive crystal arthropathy (1) were treated with infliximab (n = 10) and etanercept (n = 4). All patients showed organ-threatening progression of their diseases with resistance to conventional immunosuppressive medication. Therapeutic benefit was assessed clinically and by documenting organ-specific functional and morphological alterations. Side effects were compared with the data of our clinic's rheumatoid arthritis (RA) patients treated by TNF inhibitors.


RESULTS
A rapid and dramatic beneficial effect was documented in 9 patients and a moderate one in 5. Best responses (clinical and laboratory parameters) were seen in patients with macrophage activation syndrome/adult Still's disease and Behçet's disease, while the results were less impressive in those with Wegener's disease, Cogan's syndrome, idiopathic cerato-scleritis and lymphomatous tracheobronchitis. In all cases immunosuppressive agents and systemic glucocorticoids could be reduced or discontinued.


CONCLUSIONS
TNF inhibition may be highly effective in patients with severe, therapy-resistant chronic inflammatory disorders.
Aeberli
Daniel
D
Department of Rheumatology and Clinical Immunology/Allergology, University Hospital (Inselspital), Bern, Switzerland.
Oertle
Stefan
S
Mauron
Heribert
H
Reichenbach
Stephan
S
Jordi
Beat
B
Villiger
Peter M
PM
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001168:Arthritis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D001327:Autoimmune Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D001528:Behcet Syndrome / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D029481:Bronchitis, Chronic / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D002908:Chronic Disease; D000068800:Etanercept; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D000069285:Infliximab; D007642:Keratosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012074:Remission Induction; D015423:Scleritis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D015398:Signal Transduction / Q000187:drug effects* / Q000502:physiology; D016706:Still's Disease, Adult-Onset / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D013577:Syndrome; D014136:Tracheitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068800:Etanercept