Up regulation of TNF-alpha, interferon gamma in ankylosing spondylitis during treatment with etanercept
This article really raises some concern with me (beyond my previous level of concern over this class of drugs). Recall that TNF-alpha is a cytokine that controls many other aspects of the immune system and is generally thought of as an up-regulator of the immune system. However, we do know that this class of molecule is also important in fighting cancer cells. Elevated TNF-alpha levels are associated with autoimmune diseases such as rheumatoid arthritis, ankylosing spondylitis and Crohns and a new class of drugs “binds up” these TNF-alpha molecules floating around in an attempt to lower clinical aspects of these conditions.
However, in this article we see that etanercept (a TNF-alpha blocker) surely does binds up TNF-alpha, but the T-cells of the body respond by producing even more. While this may be okay while on the therapy, what happens with the patient terminates medication usage? Will this “super” elevated TNF-alpha level result in even worse degree of disease than prior to medication usage? We just don’t know yet.
Ann Rheum Dis — Abstracts: Zou et al. 62 (6): 561 –