23.6 : 生物学的製剤を用いた炎症性腸疾患におけるクローン病の治療薬：抗TNF

Tumor necrosis factor, or TNF, a proinflammatory cytokine, exists in soluble or membrane-bound form.

TNF-receptor interaction triggers NF-κB, T-cell activation, and leukocyte infiltration, resulting in Crohn's disease-associated transmural inflammation, making TNF a prime therapeutic target.

Anti-TNF therapy employs IgG₁ monoclonal antibodies like infliximab, adalimumab, and golimumab. Also, a recombinant antibody, certolizumab, lacking the Fc portion, features a Fab fragment conjugated to polyethylene glycol.

Infliximab is administered via intravenous infusions, whereas the others are usually given subcutaneously.

They bind to TNF and block TNF-receptor interaction, inhibiting inflammatory cellular responses.

 In addition, their Fc portion promotes antibody-mediated apoptosis of activated immune cells, effectively curbing inflammation.

Notably, they cause serious infections like bacterial sepsis, tuberculosis, and hepatitis B reactivation.

Additionally, infusion reactions such as fever, headache, and chest pain may also occur.