TNF-alpha in asthma

Although only 5-10% of patients with asthma are relatively unresponsive to treatment with inhaled corticosteroids, refractory asthma represents an important condition as these patients suffer considerable morbidity and mortality and consume a disproportionately large amount of health resource. Treatment options are limited and there is a large unmet clinical need for additional therapies. TNF-α is a proinflammatory cytokine, which has been implicated in many aspects of the airway pathology in asthma and has recently been highlighted as potentially important in refractory asthma. The development of neutralising biological agents against TNF-α has allowed the testing of its role in vivo. Preliminary studies have demonstrated an improvement in lung function, airway hyperresponsiveness, asthma quality of life and a reduction in exacerbation frequency in patients treated following anti-TNF-α therapy. We have reviewed the evidence associating TNF-α with asthma airway biology and summarise the findings of currently published clinical trials of anti-TNF-α therapy in asthma.