Tumour necrosis factor alpha (TNF-alpha) is a key molecule of the
inflammatory response and data derived from studies in experimental
animal models and humans suggest that TNF-alpha may be implicated in the
pathogenesis of various autoimmune and non-infectious inflammatory
conditions. Over the past decade pharmaceutical agents directed against
TNF-alpha (infliximab, adalimumab and etanercept) have been widely and
successfully employed for the management of rheumatoid arthritis (RA),
ankylosing spondylitis (AS), psoriasis, psoriatic arthritis, juvenile
idiopathic arthritis and inflammatory bowel disease, whereas two novel
anti-TNF-alpha agents, golimumab and certolimumab pegol, recently
entered the market for the treatment of RA, AS, Crohn’s disease and
psoriasis. Encouraged by the positive results obtained from the use of
TNF-alpha antagonists in terms of efficacy and safety and due to the
increasingly accumulating evidence regarding the implication of
TNF-alpha in the pathogenesis of numerous disorders, anti-TNF-alpha
agents have been considered for the management of diseases other than
the ones they were initially approved for. Although in the case of
multiple sclerosis and chronic heart failure the outcome from the
administration of TNF-alpha blockers had been less than favourable, in
other cases of non-infectious inflammatory conditions the response to
TNF-alpha inhibition had been fairly beneficial. More specifically,
according to well-documented clinical trials, anti-TNF-alpha agents
exhibited favourable results in Behcet’s disease, non-infectious ocular
inflammation, pyoderma gangrenosum and hidradenitis suppurativa. In this
review we discuss the successful outcomes as well as the prospects for
the future from the off-label use of TNF-alpha antagonists