TNF blockers

TNF blockers are prescription medications used to treat autoimmune and inflammatory diseases. They are also called TNF inhibitors or anti-TNF drugs. These medicines work by targeting tumor necrosis factor alpha, a protein in the immune system that causes inflammation. Too much TNF-alpha can damage joints, skin, and organs over time.

TNF blockers are biologic agents and are commonly used in rheumatology and gastroenterology. They are commonly used in the treatment of rheumatoid arthritis, Crohn’s disease, ulcerative colitis, and other inflammatory diseases. Because they affect the immune system, they require careful monitoring and regular follow-up with a healthcare provider.

TNF blockers are biologics that block the action of tumor necrosis factor, also known as TNF-a. Tumor necrosis factor is a cytokine, a type of immune system messenger that helps control inflammation. In autoimmune diseases, the body makes too much TNF-alpha, leading to ongoing inflammation and tissue damage.

TNF blockers are monoclonal antibody–based or receptor-based therapies. They are different from traditional oral drugs and are usually given as injections or infusions. These medications are approved by the US Food and Drug Administration for several inflammatory diseases in adults and some pediatric patients.

Anti-tumor necrosis factor inhibitors or TNF blockers work by attaching to tumor necrosis factor alpha and preventing it from binding to its receptors. When TNF-alpha is blocked, the inflammatory response is reduced. This helps lower swelling, pain, stiffness, and tissue damage.

By calming the immune system, TNF blockers can slow disease progression and protect joints and organs. However, because they suppress part of the immune system, they can increase the risk of infections. TNF blockers may be used alone or as part of combination therapy with other DMARDs, such as methotrexate, depending on the condition being treated.

Common TNF blockers and related biologic therapy options include:

• Adalimumab (Humira)
• Infliximab (Remicade)
• Etanercept (Enbrel)
• Golimumab (Simponi, Simponi Aria)
• Certolizumab pegol (Cimzia)
• Biosimilar versions of these medications

These anti-TNF agents may differ in how they are given, how often they are used, and which conditions they are approved to treat.

TNF blockers are used to treat many autoimmune and inflammatory diseases, including:

• Rheumatoid arthritis
• Psoriatic arthritis
• Ankylosing spondylitis
• Juvenile idiopathic arthritis
• Plaque psoriasis
• Crohn’s disease and ulcerative colitis, which are types of inflammatory bowel disease
• Other rheumatic diseases and inflammatory diseases, such as uveitis

They may also be used when other treatments have not worked or caused side effects. TNF blockers are often prescribed by specialists such as rheumatologists or gastroenterologists and may be part of long-term biologic therapy.

Common side effects of TNF blockers may include:

• Injection site reactions such as redness, swelling, or pain
• Mild infections such as colds or sinus infections
• Headache
• Fatigue
• Nausea

Serious side effects may include:

• Serious infections, including tuberculosis and fungal infections
• Increased risk of lymphoma and other cancers, such as skin cancer
• Allergic reactions during or after injection or infusion
• Worsening or new heart failure
• Nervous system problems, including multiple sclerosis–like symptoms

These are not all of the possible side effects of TNF blockers. You should always seek medical advice from your healthcare provider for any questions or concerns about your medical condition or treatment. Read all patient information, medication guides, or drug information sheets that come with this medication. You can also report adverse effects to the Food and Drug Administration at www.fda.gov/medwatch or 1-800-FDA-1088.

Although these medications are generally well-tolerated and safe, there are certain warnings, precautions, and drug interactions you should be aware of.

Warnings

Before starting TNF blockers, it is crucial to discuss any existing health conditions with your healthcare provider. You should be sure that your healthcare provider is aware of all your medical conditions, including if you have:

• A history of serious or recurring infections
• Tuberculosis or exposure to TB
• Heart failure
• A history of lymphoma or other cancers
• Multiple sclerosis or other nerve disorders
• Liver disease
• A weakened immune system

Boxed Warning

TNF blockers carry a boxed warning for serious infections and malignancies. These drugs can increase the risk of life-threatening infections and certain cancers, including lymphoma, especially in children and young adults.

Contraindications

TNF blockers may not be appropriate for people who have:

• Active serious infections
• Untreated tuberculosis
• Certain severe immune system disorders
• Moderate to severe heart failure in some cases

Drug interactions

When TNF blockers are taken with other prescription drugs, over-the-counter medications, vitamins, and supplements, it may change how they work or increase the frequency or severity of side effects. Make sure that you tell your healthcare professional about anything that you are taking to avoid any negative drug interactions, including:

• Other biologic agents or biologic therapy that also suppress the immune system
• Concomitant use of DMARDs, which may increase infection risk
• Live vaccines, which should generally be avoided during anti-TNF therapy
• Other immunosuppressive drugs that further weaken immune defenses

Always tell your healthcare provider about all medications you take before starting anti-TNF treatment.