Tumour Necrosis Factor Antagonists

This chapter presents classification and mode of action, indications and dermatological uses, formulations/presentation, dosages and suggested regimens, baseline investigations, considerations and monitoring, contraindications, cautions, important drug interactions, adverse effects and their management, use in special situations, and essential patient information of Antagonists. Tumour necrosis factor (TNF) antagonists are approved for the management of psoriasis and are also indicated for psoriatic arthritis. The anti-TNF agents/TNF antagonists used in dermatology can be divided into two groups: monoclonal antibodies and soluble TNF receptors. New TNF antagonists such as golimumab and certolimumabpegol have been approved for rheumatological diseases. Loss of efficacy correlates with development of antibodies to TNF antagonists. Therefore, patients with prior psoralen and ultraviolet A therapy and intensive use of immunosuppressive drugs should be evaluated for skin cancer before and during TNF antagonist therapy. Increased immunosuppression is more likely to occur when TNF antagonists are combined with other immunosuppressive drugs such as ciclosporin.