T.Yu. NURIAKHMETOVA¹, D.I. ABDULGANIEVA^1,2

¹Kazan State Medical University of the MH of RF, 49 Butlerov Str., Kazan, Russian Federation, 420012

²Republican Clinical Hospital of the Ministry of Healthcare of the Republic of Tatarstan, 138 Orenburgskiy Trakt, Kazan, Russian Federation, 420064

 Nuriakhmetova T.Yu. ― postgraduate student of the Department of Hospital Therapy, e-mail: tatiana.afanaseva.ksmu@gmail.com, ORCID ID: 0000-0002-1902-4964

Abdulganieva D.I. ― D. Sc. (medicine), Professor, Head of the Department of Hospital Therapy, e-mail: diana_s@mail.ru, ORCID ID: 0000-0001-7069-2725

 Although tumor necrosis factor α inhibitors have revolutionized treatment of rheumatic diseases, they demonstrate inefficacy in 20-30% of cases. Predictors of primary failure include female gender, low baseline CRP level, hypoalbuminemia, smoking and obesity. The possible causes of primary inefficacy are inability of some patients to respond to the treatment due to prevailence of other inflammatory cytokines in the pathogenesis or to pharmacokinetic features, as well as significant inflammation or complications, insufficient drug dose, genetic features and early immunogenic effect. Among the mechanisms of secondary inefficacy, insufficiency of the active drug and immunogenicity are discussed, which depensd on immune system activity, genetic predisposition, nosology, drug structure and treatment regimen. The type of released anti-drug antibodies (transient or persistent) influences their effect. The currently actively discussed therapeutic drug monitoring, requiring development of standardized methods of measuring the level of biologic agents and anti-drug antibodies, will probably play an important role in clinical decision-making for optimizing and personification of biologic treatment.

Key words: TNF-α inhibitors, primary inefficacy, secondary failure, therapeutic drug monitoring, anti-drug antibodies.

(For citation: Nuriakhmetova T.Yu., Abdulganieva D.I. Inefficacy of tumor necrosis factor a inhibitors and potential options for its overcoming. Practical Medicine. 2018)

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