[Safety of anti-TNFα biological drugs].
OBJECTIVE
To analyse TNF-α antagonists (infliximab, etanercept e adalimumab) side effects published in the literature.


METHODS
Review of published studies on this matter.


RESULTS
The main side effects reported include severe infections (even though such a risk is increased per se in RA patients), possible reactivation of a previous tuberculosis, development of opportunist germs infections (mainly those with granulomas development as Aspergillus, Cryptococcus e Histoplasma). During therapy with both infliximab and etanercept development and reactivation of demyelisating diseases have been described, sometimes associated with permanent disability. Congestive heart failure, even in the absence of predisposing risk factors, development of lymphoma, mainly non-Hodgkin, and few cases of pancytopenia with hypocellular bone marrow have also been reported.


CONCLUSIONS
Since comparison studies on the 3 TNF-α antagonists have not been performed yet, at present it is not possible to suggest using one drug out of the three in different clinical conditions; undoubtedly, the safety profile represents a major criterion to choose the more appropriate drug in the daily clinical practice.
Trotta
F
F
Sezione di Reumatologia, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Ferrara, Italia. trf@unife.it
Valentini
G
G
D000068879:Adalimumab; D016907:Adverse Drug Reaction Reporting Systems; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000139:chemically induced / Q000188:drug therapy; D003711:Demyelinating Diseases / Q000139:chemically induced; D000068800:Etanercept; D006333:Heart Failure / Q000139:chemically induced; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D000069285:Infliximab; D008223:Lymphoma / Q000139:chemically induced; D009894:Opportunistic Infections / Q000209:etiology; D010198:Pancytopenia / Q000139:chemically induced; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D047889:Receptors, Tumor Necrosis Factor, Type II / Q000037:antagonists & inhibitors; D012008:Recurrence; D012216:Rheumatic Diseases / Q000188:drug therapy; D014376:Tuberculosis / Q000209:etiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014481:United States; D014486:United States Food and Drug Administration; D014775:Virus Activation / Q000187:drug effects
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D047889:Receptors, Tumor Necrosis Factor, Type II; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept