Pharmacology 300l Presentation

Tumor Necrosis Factor (TNF) Inhibitors vs. Non-Tumor Necrosis (Non-TNF) Factor
Biologics:
The fight against chronic inflammatory diseases like rheumatoid arthritis (RA), psoriatic arthritis
(PsA), and inflammatory bowel disease (IBD) has seen the rise of biologics, a powerful class of
medications that target specific aspects of the immune system. Among these, two key categories
stand out: Tumor necrosis factor (TNF) inhibitors and non-TNF biologics.

Both TNF inhibitors and non-TNF biologics offer powerful tools in managing chronic
inflammatory diseases. TNF inhibitors have established themselves as a cornerstone therapy for
several conditions, while non-TNF biologics provide a wider range of options to target specific
pathways in the immune system. Ultimately, the choice of biologic therapy is a collaborative
decision between a healthcare professional and the patient, considering individual needs and
disease characteristics.

Both TNF inhibitors and non-TNF biologics can have serious side effects, and close monitoring
by a healthcare professional is essential.
The cost of biologics can be high, and insurance coverage can vary.
New biologics are continually being developed and studied, expanding the treatment options for
inflammatory diseases.

By understanding the differences between TNF inhibitors and non-TNF biologics, patients and
healthcare professionals can work together to choose the most appropriate treatment approach for
managing chronic inflammatory diseases and improving quality of life.

Tumor necrosis factor (TNF) Inhibitors: Blocking the Inflammatory Firestarter

 Mechanism of Action: TNF-alpha is a cytokine, a signaling molecule that plays a

central role in inflammation. TNF inhibitors are engineered proteins or antibodies that
specifically target TNF-alpha. By binding to TNF-alpha, they prevent it from interacting
with its receptors on immune cells, thereby dampening the inflammatory cascade

Examples:
 Adalimumab (Humira®): Commonly used for moderate to severe rheumatoid
arthritis, psoriatic arthritis, ankylosing spondylitis, ulcerative colitis, and Crohn's disease.

 Etanercept (Enbrel®): Another widely used option for moderate to severe rheumatoid
arthritis, psoriatic arthritis, and plaque psoriasis.
 Infliximab (Remicade®): Effective in treating moderate to severe rheumatoid
arthritis, psoriatic arthritis, ankylosing spondylitis, ulcerative colitis, and Crohn's disease.

Applications: TNF inhibitors are widely used in treating moderate to severe rheumatoid
arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (inflammatory spine disease),
ulcerative colitis, and Crohn's disease (IBD).

Advantages: TNF inhibitors are highly effective in reducing inflammation, pain, and joint
damage in these conditions. They can significantly improve a patient's quality of life.

Disadvantages: Increased risk of infections, potential for allergic reactions, higher cost
compared to some non-TNF biologics.

Non-TNF Biologics: Targeting Different Players in the Inflammatory Arena

Non-TNF biologics represent a diverse group of medications that target various aspects of the
immune system beyond TNF-alpha. Here are some key examples:

 IL-1 Inhibitors: These drugs target interleukin-1, another crucial inflammatory cytokine.
Example: Anakinra (Kineret®) for specific types of arthritis.

 IL-6 Inhibitors: These medications target interleukin-6, a cytokine involved in

inflammatory processes. Examples: Tocilizumab (Actemra®) for RA and Sarilumab (Kevzara®)
for RA and PsA.

 B-Cell Inhibitors: These drugs target B cells, immune cells involved in antibody
production. Rituximab (Rituxan®) is used for some types of arthritis and certain autoimmune
diseases.

 T-Cell Inhibitors: These medications target T cells, another type of immune cell.
Abatacept (Orencia®) is used for RA.

Janus Kinase (JAK) Inhibitors: These drugs target JAK enzymes involved in
transmitting signals within immune cells. Examples: Tofacitinib (Xeljanz®) for rheumatoid
arthritis RA and psoriatic arthritis PsA.

Advantages:

 Targeted Therapy: Non-TNF biologics can target specific pathways involved in

inflammation, potentially leading to more precise treatment with fewer side effects
compared to broad-spectrum immunosuppressants.
  Effective for Specific Conditions: These drugs can be particularly effective for
certain conditions where TNF inhibitors might not be as successful. For example, IL-17
inhibitors are beneficial for specific types of PsA.

Disadvantages:

 Newer and Less Established: Compared to TNF inhibitors that have been
around for longer, some non-TNF biologics might have a shorter track record in terms of
long-term safety and efficacy data.
 Trial and Error Approach: Due to the diverse range of targets, finding the most
effective non-TNF biologic for a particular patient might involve some trial and error,
potentially requiring adjustments to the treatment plan.

Choosing the Right Weapon: Factors to Consider

The decision of whether to use a TNF inhibitor or a non-TNF biologic depends on several
factors:

 Disease Type and Severity: Different biologics are more effective for specific
conditions. For example, TNF inhibitors are often the first-line therapy for moderate to
severe RA, while IL-17 inhibitors might be used for specific types of PsA.
  Response to Previous Treatments: If a patient has not responded well to
other medications, a doctor might consider a different type of biologic with a distinct
mechanism of action.
  Patient's Medical History: Certain health conditions or a history of infections
might influence the choice of biologic due to potential side effects.