title: Biology of anti-TNF agents in immune-mediated inflammatory diseases: therapeutic implications.
abstract: Biologics are increasingly being used to modify the course of immune-mediated inflammatory diseases. Some main agents are monoclonal antibodies and a fusion-protein that target TNF. This group includes adalimumab, infliximab, certolizumab pegol, golimumab and etanercept. Although the efficacy of anti-TNFs is supported by numerous randomized clinical trials, their pharmacokinetics depend on many factors, in particular immunogenicity, which can cause marked and rapid clearance and a consequent decrease in efficacy. Kinetics involve receptors that recognize the Fc fragment of the antibody and are responsible for various processes. Pharmacological advances permit optimizing the pharmacokinetics of anti-TNFs. In this review, we examine the kinetics of anti-TNF biologics, and consequent therapeutic implications, and overview some latest developments in the field. First draftsubmitted: 17 May 2016; Accepted for publication: 15 September2016; Published online: 14 October 2016.
authors.affiliation: Discipline of Rheumatology, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Levy
authors.affiliation: IDEARG, Saludcoop Clinic, Bogota, Colombia.
authors.forename: Renato
authors.initials: R
authors.lastname: Guzman
authors.affiliation: Departamento de Farmacología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Ciudad de México, Mexico.
authors.forename: Gilberto
authors.initials: G
authors.lastname: Castañeda-Hernández
authors.affiliation: Gastroenterology Service, Dr José Eleuterio González University Hospital, Monterrey, Nuevo León, Mexico.
authors.forename: Manuel
authors.initials: M
authors.lastname: Martinez-Vazquez
authors.affiliation: UCB, Brazil.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Damian
authors.affiliation: UCB, Belgium.
authors.forename: Carlos
authors.initials: C
authors.lastname: Cara
mesh_terms: D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001688:Biological Products / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006801:Humans; D007154:Immune System Diseases / Q000276:immunology / Q000628:therapy*; D007167:Immunotherapy / Q000379:methods*; D007249:Inflammation / Q000276:immunology / Q000628:therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha
keywords: Fc receptor γ immunogenicity; anti-TNF; immune-mediated inflammatory diseases; monoclonal antibodies; pharmacokinetics