Tumor Necrosis Factor (TNF) Inhibitors
What Is It?
Tumor necrosis factor is a protein in your body that causes inflammation. TNF inhibitors are drugs that help stop inflammation and are used worldwide to treat inflammatory conditions such as rheumatoid arthritis (RA), psoriatic arthritis, juvenile idiopathic arthritis, inflammatory bowel disease (Crohn’s and ulcerative colitis), ankylosing spondylitis and psoriasis.
The TNF inhibitors approved by the FDA are infliximab, adalimumab, etanercept, golimumab, and certrolizumab. These agents can be used by themselves or in combination with other medications such as prednisone, methotrexate, hydroxychloroquine, leflunomide or sulfasalazine.
How Is it Administered?
TNF inhibitors can be administered in two ways. The most common way is by self-injection, with a very small needle that delivers the medication just underneath the skin of the thighs or the abdomen. These medications can be given weekly, every other week, or every 4 weeks.
The second way is via an infusion. This is done in healthcare facilities and can take a few hours every 4–8 weeks.
Most patients feel better after 2 or 3 doses, but it may take 3 months to see the full benefit.
The most common side effect seen with the injectable drugs are skin reactions, commonly referred to as “injection site reactions.” These reactions can last up to a week. Infliximab, which is only available as an intravenous infusion, can rarely cause a severe allergic reaction with swelling of the lips, difficulty breathing and low blood pressure. The most significant side effects for all of the TNF inhibitors is an increased risk for all types of infections, including tuberculosis (TB) and fungal infections. Some of these infections may be severe. TNF inhibitors increase the risk of certain types of skin cancer, so using sun protection is recommended. TNF inhibitors have been associated, rarely, with multiple sclerosis. They are also known to worsen heart failure.
Tell Your Rheumatology Provider
TNF inhibitors should be held if the patient has high fever or is being treated with antibiotics for an infection. The medication can be restarted once the infection goes away. Tell your rheumatologist if you plan to undergo any surgery, because the medications should be held for some time before and after surgery. Patients should talk to their rheumatology provider before getting any vaccinations while using an anti-TNF drug. Some vaccinations are safe, but live vaccines should be avoided. TNF inhibitors are safe for pregnancy and breastfeeding. These medications are expensive, but they are covered by most health care insurance plans. Ask your rheumatologist about prescription assistance plans that can help you to get the medication at a lower price or free of charge.
Updated February 2023 by Karmela Kim Chan, MD, and reviewed by the American College of Rheumatology Committee on Communications and Marketing.
This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.