Tumour Necrosis Factor Antagonists

The tumour necrosis factor (TNF) family is a group of 19 cytokines that produce inflammation, apoptosis, proliferation and angiogenesis. Golimumab induces a weaker apoptotic effect than either infliximab or adalimumab. This may explain the greater efficacy of infliximab and adalimumab compared to etanercept, as well as the potentially higher risk of infections associated with their uses, especially with infliximab. TNF antagonists are approved for management of psoriasis, psoriatic arthritis and other inflammatory diseases, such as ankylosing spondylitis, inflammatory bowel disease, juvenile idiopathic arthritis and rheumatoid arthritis. The Psoriasis Area and Severity Index is a widely used measure of the clinical severity of psoriasis, whereas the Dermatology Life Quality Index is a validated tool used to evaluate the impact of skin disease on quality of life. The risk associated with TNF antagonists and Tuberculosis is widely accepted. However, the magnitude of the risk varies between the different available agents.