Tumour necrosis factor alpha (TNFα) is a potent pro-inflammatory cytokine. It is a small protein involved in immune cell signalling and is implicated in a number of autoimmune diseases. Elevated levels can be found in joints in rheumatoid arthritis, psoriatic plaques or people with psoriatic arthritis, and in synovial fluid in ankylosing spondylitis as well as being raised in other autoimmune conditions. Inhibiting TNFα can reduce other inflammatory markers with tissue restoration.^4,9

TNF inhibitors include adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab. These MABs bind specifically to TNFα and neutralise its actions by blocking the TNF interaction with two specific cell surface TNF receptors. The MAB also modulates biological responses that are modulated by TNF including levels of adhesion molecules that are involved in the movement of leukocytes in the immune response.^2,4

This group of MABs has a number of indications, with adalimumab indicated for plaque psoriasis, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, axial spondyloarthritis, Crohn's disease, ulcerative colitis, hidradenitis suppurativa, and uveitis:⁴