Biotechnology Healthcare - June 2008 - (Page TNF4) these agents noted in this Clinical Brief, therapeutic interchange may not be appropriate. Although all TNF inhibitors have been shown to be remarkably effective in the management of RA and other chronic inflammatory conditions, clinical studies have indicated that their effectiveness, safety, tolerability, and dosing requirements are not necessarily comparable in all patients. A detailed analysis of structural, binding, and functional differences between etanercept and the anti-TNF monoclonal antibodies (Table 2, page 3) reveals that these products are not alike. TNF inhibitors represent distinct biologic entities that perform diverse functional activities. In addition, evaluation of practical differences among these agents should include U.S. Food and Drug Administration-approved indications, safety profiles, immunogenicity, routes of administration, and dosing patterns. 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Switching between anti-tumour necrosis factors: trying to get a handle on a complex issue. Ann Rheum Dis. 2007;66;849–851. Wallis RS, Ehlers S. Tumor necrosis factor and granuloma biology: explaining the differential infection risk of etanercept and infliximab. Semin Arthritis Rheum. 2005;34:34–38. About the Author Joseph Flood, MD, FACR, is a clinical rheumatologist and educator with more than 20 years of experience in musculoskeletal medicine. He is president of Musculoskeletal Medical Specialists Inc., and is a member of the clinical faculty of The Ohio State University College of Medicine and Public Health in Columbus. Flood teaches medical students in all Joseph Flood, MD, four years of the medical school curFACR riculum at OSU. He is a fellow of the American College of Rheumatology, board certified in Internal Medicine and Rheumatology, and a Certified Clinical Densitometrist. Komatsu M, Kobayashi D, Saito K, et al. Tumor necrosis factor-alpha in serum of patients with inflammatory bowel disease as measured by a highly sensitive immuno-PCR. Clin Chem. 2001;47: 1297–1301. 4 http://www.amcp.org/amcp.ark?c=legislative&sc=position&id=18 http://www.amcp.org/amcp.ark?c=legislative&sc=position&id=18
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