International journal of clinical practice
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Tumour necrosis factor-alpha (TNF-alpha) is well established as a key mediator in the inflammatory response seen in various disease processes including sepsis. TNF-alpha is involved in virtually all features of septic shock and multiple organ failure. Anti-TNF-alpha strategies are thus appealing and have been effective at reducing inflammation and morbidity in certain conditions including rheumatoid arthritis and Crohn's disease. ⋯ The results suggest that the drug is well tolerated, and may be of benefit in certain groups of patients with sepsis. A large, randomised, clinical trial of afelimomab in patients with severe sepsis has recently been completed and the results are eagerly awaited. More work is necessary to identify a means of selecting which patients are most likely to benefit from this type of therapy in sepsis.