Anti-TNFα Biologics in the Pharmacotherapy of Rheumatoid Arthritis: Effectiveness and Safety of Infliximab, Adalimumab and Etanercept

Document Type : Narrative Review


BMS School of Science, Colombo-06, Sri Lanka


Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology. Traditionally, pharmacotherapy of RA involved non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs). However, focus now has been diverted to biologic DMARDs. Tumor necrosis factor alpha (TNFα) plays pleiotropic roles in RA pathogenesis. Hence, anti-TNF biologics offer attractive therapeutic utility. Literature contains numerous studies comparing either the effectiveness or the safety of the three drugs of interest; infliximab, adalimumab and etanercept, in terms of; patient response to treatment in a cohort and in vitro properties of the drugs. Concern at the absence of a review that comprehensively exploits both the effectiveness and safety, this review aims towards not only presenting the observed discrepancies, but also discussing the causes for them and providing experimental results from studies obtained via an extensive literature survey. Critical analysis of the effectiveness and safety profiles of licensed anti-TNF agents; infliximab, adalimumab and etanercept revealed that, a single drug cannot be named as the most efficacious. Nevertheless, anti-TNF therapy associates challenges of systemic toxicity, heterogenous patient response and partial remission. Advancement in research aiming at alleviating the existing drawbacks of anti-TNF therapy is essential.