Biologics Targeting Tumor Necrosis Factor

Abstract

Tumor necrosis factor (TNF) is a cytokine which is a key mediator of inflammation. Evidence from animal models of uveitis and observations on patients with uveitis provides strong support for the role of increased TNF activity in the pathogenesis of noninfectious uveitis, which is believed to be immune-mediated. Biologics that target TNF have been in use for the treatment of patients with uveitis since 2001. Five different anti-TNF biologics have been used in patients with chronic or recurrent uveitis refractory to nonbiologic agents. However, to date, only two of these agents, namely, infliximab and adalimumab, have a substantial amount of evidence supporting their clinical efficacy in noninfectious uveitis. Etanercept does not appear to be efficacious in uveitis and is not recommended for the treatment of uveitis. Golimumab and certolizumab currently only have a limited amount of data on their efficacy in treating uveitis, but could potentially be useful. Biologic TNF inhibitors appear to have a good safety profile in the short-term, but the long-term safety profile is not yet fully known. Additional drawbacks regarding the use of biologic TNF inhibitors for the treatment of uveitis include the lack of efficacy data from randomized controlled trials for specific entities of uveitis, high cost, the need for systemic administration, and the failure of some patients to achieve remission.