TNF inhibitors

TNF-alpha is a cytokine that drives inflammation and tissue damage in rheumatoid arthritis, inflammatory bowel disease and psoriasis, partly by inducing IL-1, IL-6 and adhesion molecules that recruit leukocytes. These biologics bind soluble and membrane-bound TNF-alpha and stop it engaging its p55 and p75 receptors. Infliximab and adalimumab are monoclonal antibodies; etanercept is a soluble receptor fusion protein.

• AdalimumabFully human and self-injected under the skin, unlike infliximab, a chimeric antibody given by intravenous infusion.
• InfliximabIts variable region comes from a mouse, so a past severe reaction to murine proteins rules it out; antibodies against the drug can form and cause reactions or loss of effect.

• Rheumatoid arthritis
• Crohn's disease
• Ulcerative colitis
• Plaque psoriasis and psoriatic arthritis
• Ankylosing spondylitis

• Serious infections, including invasive fungal onesKnown forSerious
• Reactivation of latent tuberculosisKnown forSerious
• Hepatitis B reactivationSerious
• Lymphoma, including hepatosplenic T-cell lymphomaSerious
• Skin cancerSerious
• New or worse heart failureSerious
• Demyelinating disease (multiple sclerosis, optic neuritis)Serious
• Lupus-like syndrome
• Low blood counts, rarely pancytopeniaSerious
• Infusion reactions (infliximab)Serious

What the class has in common. Each drug's card has its own, and Known for marks what an exam expects you to know.

• Latent tuberculosis is tested for, and treated, before the first dose; TB can still appear during treatment.
• Hepatitis B is screened for first, and carriers are monitored during and after treatment.
• Not started during an active infection; live vaccines and combination with anakinra or abatacept are avoided.
• Heart failure can worsen, so they are avoided or used with care in moderate to severe heart failure.

Written for biofideX in plain words, after checking these references:

• Adalimumab-aacf injection: label (DailyMed)
• Infliximab-dyyb for injection: label (DailyMed)
• Adalimumab (NCI Thesaurus)
• Etanercept (NCI Thesaurus)
• Adalimumab (NHS)

For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.