Immunogenicity of Anti-TNF-α Agents in Autoimmune Diseases

  • Nádia Emi Aikawa
  • Jozélio Freire de Carvalho
  • Clovis Artur Almeida Silva
  • Eloísa Bonfá


Prognosis of several autoimmune diseases, especially rheumatoid arthritis (RA), ankylosing spondylitis, Crohn’s disease (CD), and psoriasis, usually refractory to conventional treatment improved considerably with the introduction of tumor necrosis factor alpha (TNF-α) antagonistic agents, which is now available (infliximab, etanercept, and adalimumab). However, a portion of patients persists with active disease, infusion reactions, and relapses even during current biological therapy. One of the reasons for this is the associated immunogenicity to these drugs. The incentive for induction of antibodies against anti-TNF-α agent depends mainly on its constitution. Chimerical drugs have a higher capacity of inducing immunogenicity compared to completely human drugs. Among the three anti-TNF-α agents, this phenomenon has been studied mainly in patients using infliximab, especially in RA and CD. The prevalence of anti-infliximab antibodies in RA varies from 12% to 44% and seems to be inversely proportional to the level of seric infliximab and therapeutic response. The use of etanercept was associated to the development of anti-etanercept antibodies in 0% to 18% of patients, without apparent effect on effectiveness or adverse events. Studies with RA and CD patients show prevalence of anti-adalimumab antibodies from 1% to 87%. Immunosuppressive drug addiction can reduce the induction of anti-TNF-α antibodies.


Anti-infliximab Anti-etanercept Anti-adalimumab Anti-HACA Anti-TNF-α Autoimmune disease 


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Copyright information

© Humana Press Inc. 2009

Authors and Affiliations

  • Nádia Emi Aikawa
    • 1
    • 4
  • Jozélio Freire de Carvalho
    • 2
    • 3
    • 4
  • Clovis Artur Almeida Silva
    • 1
    • 4
  • Eloísa Bonfá
    • 2
    • 4
  1. 1.Pediatric Rheumatology Unit of Instituto da CriançaHospital das Clínicas da Faculdade de Medicina da Universidade São Paulo UniversitySão PauloBrazil
  2. 2.Rheumatology DivisionHospital das Clínicas da Faculdade de Medicina da Universidade São Paulo UniversitySão PauloBrazil
  3. 3.Rheumatology DivisionFaculdade de Medicina da Universidade de São PauloSão PauloBrazil
  4. 4.Centro de Dispensação de Medicação de Alto Custo (CEDMAC)Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil

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