TNF-alpha inhibitors treat inflammatory conditions such as rheumatoid arthritis and Crohn's disease.
For people with inflammatory conditions, such as rheumatoid arthritis and Crohn's disease, who have tried other medications with little success, tumor necrosis factor-alpha (TNF-alpha) inhibitors may provide some relief. These drugs block TNF-alpha — a protein that's present in larger quantities in your body if you have certain inflammatory conditions. Along with the possible benefits, TNF-alpha inhibitors may cause side effects, including some that could be life-threatening. As with all medications you take, you and your doctor must balance the risks and financial cost with the potential benefits.
How TNF-alpha inhibitors work
As part of the immune response, your body naturally produces the protein TNF-alpha to mobilize your white blood cells to fight infections and other invaders. This response temporarily causes inflammation in the affected area. Normally your body would then get rid of the TNF-alpha. But if you have rheumatoid arthritis or Crohn's disease, your body doesn't remove the TNF-alpha. This causes more and more white blood cells to travel to the affected area. As TNF-alpha continues to build up, it causes excessive inflammation, leading to pain and tissue damage.
TNF-alpha inhibitors block the action of TNF-alpha in your body. By preventing the effects of TNF-alpha, these drugs reduce inflammation and other signs and symptoms you may have.
TNF-alpha inhibitors can't cure inflammatory conditions, such as rheumatoid arthritis and Crohn's disease. But they can help you manage the signs and symptoms of your disease.
Available TNF-alpha inhibitors
Three TNF-alpha inhibitors are available by prescription.
Adalimumab (Humira)
Adalimumab is used alone or in combination with other drugs to treat rheumatoid arthritis and psoriatic arthritis. You inject adalimumab under the skin on your thighs or abdomen every other week, or sometimes weekly.
Etanercept (Enbrel)
Etanercept can be used alone or in combination with other medications for conditions such as:
- Rheumatoid arthritis
- Juvenile rheumatoid arthritis
- Psoriatic arthritis
- Psoriasis
- Ankylosing spondylitis
You inject etanercept once or twice a week under the skin of your thigh, abdomen or upper arm.
Infliximab (Remicade)
Infliximab is given as an intravenous (IV) infusion over two or three hours. You might receive two or three IV infusions over several weeks or months. For rheumatoid arthritis, the usual dosage schedule is three infusions over the first six weeks, then once every eight weeks after that.
Your doctor might prescribe infliximab if you have:
- Moderate to severe Crohn's disease
- Rheumatoid arthritis
- Psoriatic arthritis
- Ankylosing spondylitis
- Ulcerative colitis
Which TNF-alpha inhibitor is best for you?
All three TNF-alpha inhibitors are approved for the treatment of rheumatoid arthritis. However, the three drugs have never been tested against each other, so doctors don't know if one works better than the others. Instead, when deciding which medication might be best for you, you and your doctor may consider how often you'll take the medication and how it's administered. You might also want to check with your insurance provider to see if any of these medications are covered through your plan. TNF-alpha inhibitors can cost thousands of dollars per dosage. Choose a medication that best meets your needs and one that fits your budget.
Only infliximab is approved to treat Crohn's disease. Etanercept wasn't effective for Crohn's disease in clinical trials. Adalimumab is currently being tested for use in Crohn's.
Common side effects of TNF-alpha inhibitors
TNF-alpha inhibitors, like many medications, carry a risk of side effects — some more serious than others. Because TNF-alpha inhibitors are infused or injected into your body, you might notice a reaction at the injection site. Some common signs and symptoms of injection reactions include:
- Redness
- Itching
- Pain
- Swelling
- Bleeding
- Bruising
TNF-alpha inhibitors also may cause other side effects, including runny nose, sneezing, headache and dizziness. Tell your doctor if any of these signs and symptoms persist or are bothersome.
Each TNF-alpha inhibitor may cause different side effects. Read the information that comes with your medication carefully so that you know what to expect and when to seek medical attention. Talk to your doctor or pharmacist if you have any questions.
Dangerous reactions
More serious reactions to TNF-alpha inhibitors include:
-
Infections. TNF-alpha inhibitors decrease the action of the proteins that stimulate the white blood cells in your body, limiting your body's ability to fight infections. A number of infections have been reported in people taking TNF-alpha inhibitors, ranging from upper respiratory infections to tuberculosis. For this reason, your doctor will ask you about any past, current or recurring infections you may have had and might test you for evidence of infections.
Your doctor will also want to test you for tuberculosis before prescribing a TNF-alpha inhibitor, as well as fungal infections such as histoplasmosis and valley fever (coccidioidomycosis), since these infections may be more severe if you're being treated with a TNF-alpha inhibitor.
Your risk of serious infection increases if you take a TNF-alpha inhibitor in addition to the interleukin-1 antagonist anakinra (Kineret). Don't take anakinra if you're taking a TNF-alpha inhibitor. If you develop an infection while taking these medications, you may have to stop the treatment until your infection has been successfully treated.
- Lymphoma. It isn't clear whether TNF-alpha inhibitors cause lymphoma — some studies have found a link, while others haven't. People with rheumatoid arthritis have an increased risk of lymphoma even without TNF-alpha inhibitor therapy.
- Autoimmune diseases. TNF-alpha inhibitors have been associated with the development of autoimmune diseases, in which your body's defenses attack both the invading germs and the healthy tissues. In rare cases people taking TNF-alpha inhibitors have been diagnosed with an illness similar to lupus.
- Neurological and demyelinating disorders. Conditions such as myelitis, optic neuritis, Guillain-Barre syndrome, multiple sclerosis and seizure disorders have occurred in people taking TNF-alpha inhibitors.
- Blood disorders. In rare circumstances individuals taking TNF-alpha inhibitors have developed severe, sometimes fatal blood disorders.
TNF-alpha inhibitors in the future
Clinical trials are under way to investigate the use of the three currently available TNF-alpha inhibitors, as well as others, in several other diseases. Look for possible new developments in the future. For now, talk to your doctor if you think TNF-alpha inhibitors may be of benefit to you.
Last Updated: 09/27/2006
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