TNF Inhibitor


TNF Inhibitor, Anti-TNF Agent, Tumor Necrosis Factor Inhibitor, TNF-a blockers, Tumor Necrosis Factor Alpha Inhibitor

  • Contraindications
  • Relative (Consult before use)
  1. Congestive Heart Failure (NYHA Class 3 to 4)
  2. Recurrent Bacterial or Viral Infection
  3. Latent Infections (e.g. Tuberculosis, Histoplasmosis, Coccidioidomycosis)
  4. HIV Infection
  5. Hepatitis B
  6. Hepatitis C
  7. Organ Transplant on Immunosuppression
  8. Active Cancer
  9. Demyelinating Disease (e.g. Multiple Sclerosis)
  10. Pregnancy
    1. Most TNF Inhibitors may be used in pregnancy if risk outweighs benefit
    2. Some TNF Inhibitors are monitored with pregnancy registries
  11. Concurrent use of other Monoclonal Antibody
  • Precautions
  1. TNF Inhibitors predispose to serious infections and malignancy
  2. Prepare for TNF Inhibitor use with infection screening (e.g. Tuberculosis) and Immunizations
    1. See Monoclonal Antibody
  • Medications
  1. Older xTNF agents included Thalidomide
  2. Modern xTNF agents (in 2016) are primarily monoclonal antibodies
    1. Adalimumab (Humira)
    2. Certolizumab (Cimzia)
    3. Etanercept (Enbrel)
    4. Golimumab (Simponi)
    5. Infliximab (Remicade)
  • Prevention
  1. Update Vaccinations prior to starting therapy
    1. Live Vaccines may not be used concurrently with xTNF agents
  2. Screen for Tuberculosis and other infections prior to starting xTNF-a agents
  3. Requires regular lab monitoring depending on agent and condition being treated
  4. Skin Cancer Prevention with regular use of Sunscreen and Self Skin Exam
  5. Patients should seek medical evaluation for acute infectious symptoms while on xTNF agents
  • References
  1. (2018) Presc Lett 25(7): 40