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What have we learnt from targeted anti-TNF therapy?
  1. M Feldmann,
  2. R O Williams,
  3. E Paleolog
  1. Kennedy Institute of Rheumatology Division, London, UK
  1. Correspondence to Professor M Feldmann, Kennedy Institute of Rheumatology Division, Imperial College, 65 Aspenlea Road, London W6 8LH, UK; m.feldmann{at}


Anti-tumour necrosis factor (anti-TNF) therapy of patients with rheumatoid arthritis dates back to 1992, when the first proof-of-principle trials were performed in London by Maini and Feldmann. Considerable studies of the mechanism of action were performed, and insights into the way in which anti-TNF therapy delivers its benefit were obtained. In this brief review, certain aspects of knowledge acquired and the many gaps will be reviewed. Focus will be on the TNF-dependent cytokine cascade and what it means, and potential new approaches to treatment. Finally, an entertaining challenge: might many or even all unmet clinical needs be dealt with through cytokine analysis?

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  • Funding Support from Arthritis Research Campaign, Kennedy Institute of Rheumatology Trustees, Trillium Therapeutics Inc, Nuon Therapeutics Inc, which is gratefully acknowledged.

  • Competing interests MF is a consultant and shareholder for Nuon (Tranilast) and consultant to Trillium (CD200Fc).

  • Provenance and Peer review Not commissioned; externally peer reviewed.