Rheumatology International

, Volume 31, Issue 3, pp 327–337 | Cite as

Anti-TNF therapies: a comprehensive analysis of adverse effects associated with immunosuppression

  • Victoria ConnorEmail author
Original Article


Knowledge and understanding about the immunosuppressive properties of anti-TNF therapies and the adverse effects these causes have advanced over the last 10 years since the first of these drugs was approved. These drugs work by inhibiting tumour necrosis factor (TNF) in the body, which plays an essential role in the immune response to invading pathogens. Anti-TNF drugs have therapeutic value because high levels of TNF are thought to be part of the pathophysiology of many chronic inflammatory disorders such as rheumatoid arthritis and Crohn’s disease. Anti-TNF drugs are usually well-tolerated, however, there have been reports of many potentially serious adverse effects. This article will comprehensively analyse these adverse effects; the incidence, symptoms and mechanisms will be discussed. In addition, the contraindications of this class of drugs will be explored and the detection and prevention methods that should be put in place by health care professionals who treat patients on these drugs will be described.


Anti-TNF Biologics Immunosuppresion Adverse effects Rheumatology 


Conflict of interest statement

There are no conflicts of interest for this author.


  1. 1.
    Atzeni F, Sarzi-Puttini P (2008) Autoantibody production in patients treated with anti-TNF-α. Expert Rev Clin Immunol 4(2):275–280CrossRefPubMedGoogle Scholar
  2. 2.
    Deepe GS Jr, Wallis RS (2006) Tumor necrosis factor-α inhibitors and granulomatous infectious. Drug Discov Today Dis Mech 3(2):295–300CrossRefGoogle Scholar
  3. 3.
    Olsen NJ, Stein CM (2004) New drugs for rheumatoid arthritis. N Engl J Med 350(21):2167–2179, 2226Google Scholar
  4. 4.
    Wallis RS (2008) Tumor necrosis factor antagonists: structure, function, and tuberculosis risks. Lancet Infect Dis 8(10):601–611CrossRefPubMedGoogle Scholar
  5. 5.
    Kroesen S, Widmer AF, Tyndall A, Hasler P (2003) Serious bacterial infections in patients with rheumatoid arthritis under anti-TNF-α therapy. Rheumatology 42(5):617–621CrossRefPubMedGoogle Scholar
  6. 6.
    Furst DE, Wallis R, Broder M, Beenhouwer DO (2006) Tumor necrosis factor antagonists: different kinetics and/or mechanisms of action may explain differences in the risk for developing granulomatous infection. Semin Arthritis Rheum 36(3):159–167CrossRefPubMedGoogle Scholar
  7. 7.
    Wallis RS, Ehlers S (2005) Tumor necrosis factor and granuloma biology: explaining the differential infection risk of etanercept and infliximab. Semin Arthritis Rheum 34(5 SUPPL):34–38CrossRefPubMedGoogle Scholar
  8. 8.
    Callen JP (2007) Complications and adverse reactions in the use of newer biologic agents. Semin Cutan Med Surg 26(1):6–14CrossRefPubMedGoogle Scholar
  9. 9.
    Antoni C, Braun J (2002) Side effects of anti-TNF therapy: current knowledge. Clinl Exp Rheumatol 20(6 Suppl 28):S152–S157Google Scholar
  10. 10.
    Weinberg JM, Buchholz R (2006) TNF-alpha inhibitors, 1st edn. Birkh©Þuser Verlag, BaselGoogle Scholar
  11. 11.
    Stone JH (2008) Tumor necrosis factor-alpha inhibitors: risk of bacterial, viral, and fungal infections. Accessed Oct 2008
  12. 12.
    Desai SB, Furst DE (2006) Problems encountered during anti-tumor necrosis factor therapy. Best Pract Res Clin Rheumatol 20(4):757–790CrossRefPubMedGoogle Scholar
  13. 13.
    Stone JH (2008) Tumor necrosis factor-alpha inhibitors: risk of malignancy. Accessed Oct 2008
  14. 14.
    Robinson WH, Genovese MC, Moreland LW (2001) Demyelinating and neurologic events reported in association with tumor necrosis factor α antagonism: by what mechanisms could tumor necrosis factor an antagonists improve rheumatoid arthritis but exacerbate multiple sclerosis? Arthritis Rheum 44(9):1977–1983CrossRefPubMedGoogle Scholar
  15. 15.
    Stone JH (2008) Tumor necrosis factor-alpha inhibitors: an overview of adverse effects. Accessed Oct 2008
  16. 16.
    Lee SJ, Kavanaugh A (2005) Adverse reactions to biologic agents: focus on autoimmune disease therapies. J Allergy Clin Immunol 116(4):900–905CrossRefPubMedGoogle Scholar
  17. 17.
    Danila MI, Patkar NM, Curtis JR, Saag KG, Teng GG (2008) Biologics and heart failure in rheumatoid arthritis: are we any wiser? Curr Opin Rheumatol 20(3):327–333CrossRefPubMedGoogle Scholar
  18. 18.
    Balakumar P, Singh M (2006) Anti-tumor necrosis factor-α therapy in heart failure: future directions. Basic Clin Pharmacol Toxicol 99(6):391–397CrossRefPubMedGoogle Scholar
  19. 19.
    Stone JH (2008) Tumor necrosis factor-alpha inhibitors: induction of antibodies, autoantibodies, and autoimmune diseases. Accessed Oct 2008
  20. 20.
    Moots RJ, Taggart A, Walker D (2003) Biologic therapy in clinical practice: enthusiasm must be tempered by caution. Rheumatology 42(5):614–616PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.University of LiverpoolLiverpoolUK

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