Non-TNF biologics: IL-6, IL-17, IL-12/23, B-cell and T-cell costimulation blockade
How each non-TNF biologic class works, why the cytokine targeted predicts which diseases respond and which adverse effects appear (masked CRP with IL-6 blockade, candidiasis and IBD with IL-17 blockade, hypogammaglobulinaemia and hepatitis B reactivation with rituximab), and how to choose by mechanism.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Non-TNF biologics each block one node of the immune response. Which node predicts which disease responds and which adverse effect appears.
- Rheumatoid arthritis responds to IL-6, B-cell and costimulation blockade (and TNF and JAK). It responds poorly to IL-17 or IL-23 blockade.
- Psoriasis and spondyloarthritis are IL-23/IL-17 axis diseases. Axial disease responds to IL-17 but not IL-23 blockade.
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Sources
- EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 updateAnnals of the Rheumatic Diseases (Smolen et al., 2023;82:3-18), 2022 update
- ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 updateAnnals of the Rheumatic Diseases (Ramiro et al., 2023;82:19-34), 2022 update
- EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 updateAnnals of the Rheumatic Diseases (Gossec et al., 2024;83:706-19), 2023 update
- Australian Rheumatology Association: patient medicine information and position statements on biological DMARDsAU/NZAustralian Rheumatology Association, online, accessed November 2026
- Pharmaceutical Benefits Scheme: biological DMARDs for rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitisAU/NZAustralian Government Department of Health, Disability and Ageing, Schedule accessed November 2026
- Trial of tocilizumab in giant-cell arteritis (GiACTA)New England Journal of Medicine (Stone et al., 2017;377:317-28), 2017
- Last updated
- 14 November 2026
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