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Anti-TNF in rheumatoid arthritis: an overview

Anti-TNF Therapie in der Rheumatoiden Arthritis – ein Überblick

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Summary

Since the introduction of tumor necrosis factor (TNF)-α inhibitors, the treatment of rheumatoid arthritis (RA) has been revolutionized. The approach of targeting TNF-α has considerably improved the success in the treatment of RA. Over the last 3 decades five different TNF-α inhibitors have been administered: infliximab, etanercept, adalimumab, golimumab, and certolizumab-pegol. All of them show excellent efficacy with similar rates of clinical response and prevention of radiographic disease progression. With improved therapies, treatment strategies have also changed, with the aims now being to achieve and maintain remission. Most recently, the discussion expands to the issue of treatment reduction in patients who have achieved sustained remission; here, the discontinuation of TNF-α inhibitor therapy has become an area of interest, given obvious economic and risk-benefit evaluations. However, only little is known if “biologic free” remission is possible in patients with sustained remission following intensive TNF-α inhibitor therapy.

Zusammenfassung

Die Entdeckung und Einführung von Tumor-Nekrosis-Faktor Alpha (TNF-α) Blockern hat die Therapie der Rheumatoiden Arthritis (RA) revolutioniert. Der direkte Therapieansatz am Zytokine TNF-α führte zu beachtlichen Erfolgen und Ansteigen von Remissionsraten. Innerhalb der letzten drei Dekaden wurden fünf verschiedene TNF-α Blocker entwickelt und am Markt eingeführt: Infliximab (IFX), Adalimumab (ADA), Etanercept (ETN), Golimumab (GLM) und Certolizumab Pegol (CZP). Alle diese Medikamente zeigen ausgezeichnete Effektivität mit vergleichbaren Erfolgsraten betreffend klinischer Aktivität und radiologischer Progression. Durch Verbesserung der Therapeutika kam es schlussendlich zu Adaptierung und Optimierung von Therapiestrategien, mit Erreichen und Erhalten von Remission als oberstes Therapieziel. Da dauerhafte Remission mittlerweile ein realistisches Szenario darstellt, und in Anbetracht sozio-ökonomischer und Nutzen-Risiko Überlegungen beschäftigen sich neuere Arbeiten mit dem Thema der Therapiereduktion in dieser Patientenpopulation. Bis dato ist allerdings nur wenig darüber bekannt, ob „biologika- freie“ Remission in Patienten mit vorangegangener intensiver TNF-α Therapie eine Möglichkeit darstellt.

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Correspondence to Helga Radner MD.

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Radner, H., Aletaha, D. Anti-TNF in rheumatoid arthritis: an overview. Wien Med Wochenschr 165, 3–9 (2015). https://doi.org/10.1007/s10354-015-0344-y

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