Molecular Evidence (rationale) for TNF-alpha targeted therapy in iMCD patients:


  • Not great evidence for targeting TNF-alpha


Case Reports of anti-TNF-alpha therapy for iMCD patients:


Etanercept is an anti-cytokine monoclonal antibody that targets TNF-alpha. 

  • 61-year-old female with iMCD received 2nd-line treatment of etanercept and corticosteroids at 36 months with no response. Patient previously received 1st-line siltuximab achieved partial remission (improved blood counts, lymphadenopathy resolved, but intermittent fever and rash persisted) for 36 months. 3rd-line consecutive plateletpheresis for thrombocytosis and then cladribine for 5 days (non-cytoxin-based chemo) with no response. Patient was then treated with repeated courses of steroids, and later was started on naprosyn for possible neoplastic fever. She also received a weekly dose of rituximab for 8 weeks, with persistence of disease flare up. Patient achieved a complete remission of 7 months on 5th-line anakinra. (El-Osta et al)

 

Clinical Trial targeting TNF-alpha in iMCD: 


No clinical trial targeting TNF-alpha iMCD patients have been conducted.