Types of common anti-TNF agents

  • Infliximab (Brand Names: Remicade®, Inflectra®, Renflexis®, Avsola®)
  • Adalimumab (Brand Name: Humira®)
  • Certolizumab (Brand Name: Cimzia®)
  • Golimumab (Brand Name: Simponi®)

What are anti-TNF agents and what are they used for?

Anti-TNF medicines are antibodies that block a hormone called tumor necrosis factor (TNF). TNF is made by white blood cells and causes inflammation. Anti-TNF medicines can help patients go into and stay in remission. Anti-TNF medicines are also used to heal fistulas and help the fistulas to close.

How would anti-TNF agents be given to me?

Infliximab (Remicade®, Inflectra®, Renflexis®, Avsola®)

  • Infliximab is given by an intravenous (IV) infusion (into a vein) by a healthcare team member.
  • When you first start taking Remicade®, you will get one dose and then another dose at 2 weeks and then at 6 weeks after the first dose. After these first three doses, Remicade® is typically given every 8 weeks by IV infusion. However, some patients need infliximab more frequently than every 8 weeks.
  • The infusion usually lasts 2-3 hours (but could be shortened to 1 hour as time goes on). You will get your infusion in an outpatient or hospital-based office or infusion center. Your GI doctor will check to see how well infliximab works for you and may change your dose or the time between doses.

Adalimumab (Humira®)

  • Humira® is given by an injection (shot) into the skin every 2 weeks (or possibly more often, depending on dosing). The shot is with a very small needle and relatively painless for most patients.

Certolizumab (Cimzia®)

  • Cimzia® is given by an injection into the skin, once every 2 weeks or twice every 4 weeks, depending on dosing

Golimumab (Simponi®)

  • Simponi® is given by an injection into the skin, usually every 4 weeks although sometimes it can be given more often.

Parents and children often learn how to give Humira and Cimzia® and Simponi® shots. These medicines can be given at home.

Are there any medicines I cannot take with anti-TNF agents?

Anti-TNF medicines do not seem to cause any major problems when you take them with other medicines.

Is it safe to take anti-TNF agents for a long period of time?

Anti-TNF agents are often used for long periods of time with very good results. This is not a medicine that is used for only a few months. Some people can stop these medicines if they are doing very well. This is an important conversation to have with your GI doctor.

Are there any possible side effects from anti-TNF agents?

Minor side effects

  • Rash
  • Flu-like symptoms a week after the infusion
  • Injection site reaction

Major side effects

  • Liver injury
  • Decreased blood cell count
  • Increased risk of infection

There is a risk of an allergic reaction and an increased risk of infection with any anti-TNF medicine. If you experience any of the following symptoms you should NOTIFY YOUR GI DOCTOR RIGHT AWAY OR CALL 911 OR GO TO THE NEAREST EMERGENCY ROOM.

  • Delayed allergic reactions
    Allergic reactions can happen during or shortly after an infusion or injection of an anti-TNF medicine. They can also happen as a delayed reaction, 3 to 12 days after receiving an anti-TNF drug. This is different than an anaphylactic reaction. Symptoms of this kind of allergic reaction may include fever, rash, headache and muscle or joint pain.

    Some patients can also have a “lupus-like” reaction that may include chest discomfort, shortness of breath, joint pain or a rash on the cheeks or arms that gets worse in the sun. Contact your GI doctor if you get any of these symptoms.
  • Nervous system disorders
    There have been rare cases where people taking anti-TNF medicines have gotten arm or leg weakness, numbness, or tingling or had changes in their vision. If you develop these symptoms, call your GI doctor right away.
  • Cancer
    Some medicines that suppress your immune system can increase your risk for getting some cancers, like non-melanoma skin cancer. More than 30 IBD patients have developed hepatosplenic T-cell lymphoma. This is a very, very rare and aggressive form of lymphoma that has been seen mainly in teenagers and young adults, mostly males. Most of these patients received azathioprine (6-MP) and an anti-TNF medicine though not always at the same time. This form of lymphoma usually starts with an enlarged liver and spleen as well as low platelet counts, fever, weight loss, and night sweats. Many of these patients died from this lymphoma. It appears that it is more likely that this is due to the azathioprine than the anti-TNF medicines.

Rev. 8/2018. Mass General for Children and Massachusetts General Hospital do not endorse any of the brands listed on this handout. This handout is intended to provide health information so that you can be better informed. It is not a substitute for medical advice and should not be used to treatment of any medical conditions.