Tumor necrosis factor inhibitors: Clinical implications of their different immunogenicity profiles

The beneficial effects of the anti-tumor necrosis factor (TNF) monoclonal antibodies infliximab and adalimumab and the soluble receptor fusion protein etanercept in the treatment of rheumatoid arthritis and a variety of other inflammatory disorders have been well described. However, less is known about the propensity of these agents to stimulate the production of antibodies against themselves and the clinical implications of such immunogenicity. A better understanding of the differential immunogenicity of these agents may help explain certain phenomena that have been reported with clinical use of anti-TNF agents (eg, infusion reactions [all agents], the need for increasing doses with prolonged use [infliximab]). This review will discuss our current understanding of the diverse immunogenic profiles of currently marketed anti-TNF agents.