Anti-TNFs

TNF stands for tumor necrosis factor, a protein made by certain white blood cells that are an important part of the inflammatory process. TNF induces necrosis (death) of tumor cells. But TNF is a cytokine that affects many processes and functions, including inflammation. By blocking TNF, anti-TNF drugs interfere with a key factor in the inflammatory process that underlies IBD.
Adalimumab (Humira) and infliximab (Remicade) are used for the treatment of moderately to severely active Crohn’s disease or ulcerative colitis. Certolizumab (Cimzia) is approved only as treatment for Crohn’s disease only.
Generic Brand name UC FDA Approved Crohn’s FDA Approved
adalimumab Humira 2012 2007
certolizumab Cimzia Not Approved 2008
infliximab Remicade 2005 1998
vedolizumab Entyvio 2014 2014

How is it administered?

Anti-TNFs are administered either by subcutaneous injection (adalimumab and certolizumab) or as an intravenous infusion over two hours (infliximab).

When will I feel better?

Some people respond to Remicade in the first 24 to 72 hours after an infusion. But it may take the initial three infusions over the course of three weeks to experience some symptom relief. With Humira and Cimzia, the maximum relief usually comes after people have received the first several starting doses given over four to eight weeks. Sometimes symptoms improve sooner. In general, about two out of every three patients people respond within the first doses of an anti-TNF medication. Between 30% and 50% will maintain a response for a year. Those doing well after a year will probably keep on doing well. Dosage adjustments are common. Between 30% and 50% of patients will require a change in dose, or a change in the interval between doses, some time during the course of therapy. About one in every 10 patients stop taking a particular anti-TNF drug each year because it stops working or because of its side effects. If that happens to you, you might switch to a different anti-TNF medication or to different class of medications.

Side effects

Before starting any anti-TNF medication, you will need to be tested for tuberculosis and hepatitis B. Anti-TNF medications can result in a reactivation of latent TB and hepatitis B infections. If either the TB or hepatitis tests are positive, you will need to be treated for those diseases before starting your medication.

  • hypersensitivity
  • injection site reactions
  • infection
  • liver abnormalities
  • Lupus-like syndrome
  • worsening of congestive heart failure
  • nervous system disorders
  • lymphoma

How long do I need to take an anti-TNF medication?

Anti-TNFs are designed to be taken as maintenance treatment to treat and prevent flares. You will probably need to take anti-TNF medication for many years, even during the times when you are feeling well.

Anti-TNF drugs while Pregnant

Women planning to become pregnant should discuss their treatment options with their care team in clinic. Usually women are advised to continue with their maintenance therapy during their pregnancies. An uncontrolled flare of your disease can be harmful to the baby. Studies have not shown an increase in any adverse events for the mother or fetus when the mother is treated with Remicade or Humira during their pregnancy.

Women who are being treated with Remicade or Humira during pregnancy usually discontinue the medications at the 32nd week of the pregnancy so the baby can be appropriately vaccinated when born. Typically, treatment is resumed after the baby is born, but it is important to discuss this with your care term.
Remicade and Humira is usually not detectable in breast milk. Even if it were, absorption by the baby is unlikely because the medications are probably destroyed in the infant’s gastrointestinal tract. Follow-up studies of infants whose mothers were treated with Remicade during their pregnancy and while they were breastfeeding haven’t found any adverse effects on the children.
Because Cimza is a large protein, it is thought that the amount of the medication that can cross the placenta and reach the developing baby is small. For that reason, pregnant women can keep on taking the drug, even after the 32nd week of their pregnancy. Animal studies have found no evidence of harm to the fetus from Cimzia.
It’s probably safe for breastfeeding mothers to be treated Cimzia. Very little gets into breast milk, and the drug is not absorbed from the infant’s gastrointestinal tract, further reducing the chance of exposure.