TNF binding proteins (under construction)

TNF-α binding proteins can be monoclonal antibody in nature or can be recombinant proteins which act as circulating TNF-α receptors. To date their immunosuppressive activity is utilised in the treatment of autoimmune conditions.

Anti-TNF-α monoclonal antibodies

Adalimumab was the first fully human monoclonal approved by the FDA. It induces immunosuppression by selectively binding to TNF-α. It is approved for the treatment of auto-immune diseases including rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis, plaque psoriasis, Crohn's disease, hidradenitis suppurativa, and in the US non-infectious intermediate, posterior and panuveitis.

Infliximab binds soluble and membrane-anchored TNF-α, bringing about immunosuppression. Infliximab is approved for the treatment of auto-immune diseases including rheumatoid arthritis (in combination with methotrexate), ankylosing spondylitis, psoriatic arthritis, plaque psoriasis, Crohn's disease and ulcerative colitis.

Golimumab is used in adults to treat moderate to severe active rheumatoid arthritis, active psoriatic arthritis, active ankylosing spondylitis and moderate to severe ulcerative colitis.

Certolizumab pegol is a antibody derivative, comprising only the antigen-binding Fab' fragment of an anti-TNF-α monoclonal. It is conjugated with polyethylene glycol to increase its circulating half-life as Fab' fragments are normally rapidly degraded in vivo. Used to treat rheumatoid arthritis and Crohn's disease.

TNF-α receptor agent

Etanercept is a dimeric recombinant protein fusing the TNF receptor 2 to the Fc region of the human IgG1 antibody, so it effectively immuno-neutralises circulating TNF-α.  It is used to treat severe active rheumatoid arthritis in adults, severe juvenile idiopathic arthritis, ankylosing spondylitis, and severe plaque psoriasis.