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Expert Rev Clin Immunol. 2019 Feb;15(2):189-198. doi: 10.1080/1744666X.2019.1550359. Epub 2018 Nov 30.

Risks associated with use of TNF inhibitors in children with rheumatic diseases.

Author information

1
a Department of Pediatrics, Desio Hospital , ASST Monza , Desio (MB) , Italy.
2
b PhD student in Biomedical Sciences , University of Florence , Florence , Italy.
3
c Department of Medical Biotechnology , University of Siena , Siena , Italy.
4
d Rheumatology Unit, Meyer Children's Hospital , University of Florence , Florence , Italy.
5
e Department of Neurosciences, Psychology, Drug Research and Child Health, Rheumatology Unit, Meyer Children's Hospital , University of Florence , Florence , Italy.

Abstract

Introduction: Tumor necrosis factor alpha (TNF-α) is a pro-inflammatory cytokine involved in the pathogenesis of many inflammatory diseases. Several drugs blocking TNF-α are employed in clinical practice in pediatrics. Given their action on the immune system, TNF-α inhibitors have raised concerns on their safety profile since their introduction. A broad spectrum of side effects related to TNF inhibition has been reported: immunogenicity, infectious diseases, malignancies, and others. Areas covered: In order to assess the risk related to the use of anti-TNF-α agents in children with rheumatic diseases we analyzed data obtained from retrospective and prospective safety studies, case reports and case series, and controlled trials. Expert commentary: Anti-TNF-α agents have shown a remarkably good safety profile in the pediatric population so far. However, there are lots of questions to be answered and maintaining active surveillance on these drugs is necessary in order to not overlook any possible unexpected adverse effects.

KEYWORDS:

TNF-α; biologics; immunogenicity; infections; juvenile idiopathic arthritis; malignancies; side effects

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