Rheumatology
Anti-TNF biologics
TNF-alpha inhibitors (e.g. adalimumab, infliximab) — Injectable "biologic" drugs that calm severe inflammatory disease by blocking a key inflammatory signal.
Education and reference only. This is a plain-language class overview — it deliberately contains no doses. Always check the current Summary of Product Characteristics (SmPC), the BNF and your local formulary before prescribing or administering any medicine.
What it is
Anti-TNF biologics are targeted, injectable treatments for severe inflammatory conditions — such as rheumatoid and psoriatic arthritis, ankylosing spondylitis, inflammatory bowel disease and severe psoriasis — used when standard treatments have failed. They are started and supervised by specialists.
How it works
They are antibodies (or antibody-like proteins) that bind and neutralise tumour necrosis factor (TNF), a master signal that drives inflammation. Switching off this signal dampens the inflammatory disease — but it also blunts part of the immune system's defence against infection.
In practice
In practice anti-TNF drugs transformed the treatment of severe rheumatoid and other inflammatory arthritis, inflammatory bowel disease and psoriasis when conventional drugs are not enough. Because they suppress a central part of the immune defence, the dominant theme is infection: patients are screened before starting for latent tuberculosis and for hepatitis B and C (the drug can reactivate these), brought up to date with appropriate vaccinations beforehand, and told to seek help promptly with signs of infection. Live vaccines are generally avoided during treatment. Other points include a small increased risk of certain infections and possibly some cancers, caution or avoidance in significant heart failure and in demyelinating disease, and the practical reality that these are given by injection or infusion and are continued under specialist supervision with regular review. Many are now available as lower-cost "biosimilars".
Examples
Practical use
How to take it & use it well
- Adalimumab, etanercept and infliximab are biologic injections or infusions used for conditions such as rheumatoid arthritis and inflammatory bowel disease.
- Adalimumab and etanercept are usually given as injections under the skin, often self-administered after training, while infliximab is given as a drip in hospital.
- Before starting, you will be screened for infections including tuberculosis and hepatitis, as these can flare up on treatment.
- Store injection devices in the fridge as directed, let them reach room temperature before use, and rotate injection sites.
- Avoid live vaccines while on treatment, but keep up with recommended non-live vaccines such as the annual flu jab.
- Report any signs of infection such as fever, cough or feeling generally unwell promptly, as infections can become serious.
Common uses
- Severe rheumatoid, psoriatic and other inflammatory arthritis
- Inflammatory bowel disease (Crohn's, ulcerative colitis)
- Severe psoriasis and ankylosing spondylitis
Monitoring
- Pre-treatment TB and hepatitis screening; vaccination review
- Signs of infection throughout; disease-activity response
- Periodic specialist review and blood tests
Weighing it up
Advantages & disadvantages
Advantages
- Can greatly reduce inflammation, pain and joint or bowel damage in conditions that have not responded to standard treatment.
- Often improve quality of life, mobility and ability to work.
- Many can be given conveniently at home by self-injection.
- Can reduce the need for steroids and their long-term side effects.
Disadvantages
- Increase the risk of serious infections, including reactivation of tuberculosis or hepatitis B.
- Live vaccines must be avoided during treatment.
- Injection or infusion reactions can occur.
- Regular monitoring and a commitment to ongoing treatment are needed.
- There may be a small increased risk of certain other conditions, which your team will discuss.
Key safety principles
What to watch for
- Increased infection risk — screen for latent TB and hepatitis B/C before starting (risk of reactivation); seek help promptly with infections.
- Avoid live vaccines during treatment; update vaccinations beforehand.
- Caution/avoid in significant heart failure and demyelinating disease; small possible increase in certain cancers.
Key interactions
What to avoid or check alongside
- Combining with other strong immune-suppressing medicines further increases infection risk and is monitored carefully.
- Live vaccines can cause infection because the immune system is suppressed, so they are avoided during treatment.
- Using with anakinra or abatacept is generally avoided because of a higher risk of serious infection.
- Untreated latent tuberculosis or hepatitis can reactivate, which is why screening is done before starting.
Patient & carer advice
- Seek medical advice early if you develop signs of infection (fever, persistent cough, night sweats)
- Avoid "live" vaccines and tell any vaccinator you take this
- Carry a biologics alert card and keep up your monitoring
Use with
Related clinical calculators
Dose and risk decisions for this class often depend on renal function, weight or bleeding/stroke risk. These tools help:
Answers
Anti-TNF biologics: frequently asked questions
Why am I screened for TB and hepatitis before starting?
Anti-TNF biologics suppress the immune system and can reactivate hidden infections such as tuberculosis or hepatitis B. Screening beforehand allows these to be treated or monitored so they do not flare up dangerously.
Can I have vaccinations on these medicines?
You should avoid live vaccines while on anti-TNF treatment because they could cause infection. Non-live vaccines, such as the annual flu jab and COVID vaccines, are encouraged and important.
What should I do if I think I have an infection?
Tell your team promptly about any fever, cough, sore throat, urinary symptoms or feeling generally unwell. Infections can become serious quickly while your immune system is suppressed and may need urgent treatment.
Can I inject these at home?
Adalimumab and etanercept are commonly self-injected at home after training, while infliximab is usually given as a hospital infusion. Your nurse will teach you safe technique and storage.
Will I have to take this long term?
Many people take anti-TNF biologics for a long time to keep their condition controlled. Your team reviews how well it is working and your safety regularly, and treatment may be adjusted over time.
Authoritative sources
Always verify against the source
This overview is for orientation. For doses, interactions, contra-indications and the full monograph, use:
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