Targeting tumor necrosis factor alpha - New drugs used to modulate inflammatory diseases

Tumor necrosis factor alpha (TNF-alpha) is an inflammatory cytokine with a role in several biologic systems, including immune modulation and host defense against tumors and infections. The role of TNF-alpha in inflammatory diseases is increasingly understood. Its role in the pathophysiology of Crohn's disease, rheumatoid arthritis, and many inflammatory skin disorders is well established. Three drugs that target TNF-alpha recently have come to market. Thalidomide enhances the degradation of mRNA encoding TNF-alpha, but also has immune-modulating properties. This drug has a notorious history, but is emerging as a therapeutic agent to treat inflammatory, autoinumme, and neoplastic diseases. Etanercept and infliximab are newer, more specific TNF-alpha antagonists that are showing promise as therapeutic agents. The authors describe these three drugs, their mechanisms, and indications. In addition, they speculate about the potential role of these TNF-alpha antagonists in treating various skin conditions.