Review of Biologics in Children With Rheumatic Diseases

Shabina Habibi; Athimalaipet V Ramanan


Int J Clin Rheumatol. 2012;7(1):81-93. 

In This Article

Anti-TNF-α Agents

TNF-α has been found to play an important role in the pathogenesis of a variety of inflammatory diseases, including JIA.[5–7] TNF-α-blocking agents bind to and antagonize the effects of TNF-α, acting on both the free molecule in serum and the cell surface-bound molecule. Etanercept, adalimumab and infliximab are the three TNF-α agents used in the therapy of JIA, especially the polyarticular subtype, and juvenile psoriatic arthritis, with polyarticular involvement. Etanercept is a soluble TNF receptor fusion protein, consisting of the extracellular domain of the TNF-α receptor combined with the Fc portion of human immunoglobulin. It binds to soluble TNF-α and thus decreases downstream TNF-α receptor-mediated signaling. Infliximab is a chimeric human–mouse monoclonal antibody directed against TNF-α, whereas adalimumab is a fully humanized monoclonal antibody against TNF-α. Both infliximab and adalimumab bind to both the soluble and membrane-bound TNF-α, neutralizing its effect. These different mechanisms of action between the soluble receptor fusion protein and monoclonal antibodies have implications in choice of and side effects associated with biologics.


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