Anti-Tumor Necrosis Factor Drugs (Anti-TNF drugs): Uses, Side Effects

Anti-TNF drugs or TNF inhibitors are a group of medications used worldwide to treat inflammatory conditions such as rheumatoid arthritis (RA), psoriatic arthritis, juvenile arthritis, inflammatory bowel disease (Crohn’s and ulcerative colitis), ankylosing spondylitis, and psoriasis. They reduce inflammation and can stop disease progression by targeting an inflammation-causing substance called Tumor Necrosis Factor (TNF).

In healthy individuals, excess TNF in the blood is blocked naturally, but in those who have rheumatic conditions, higher levels of TNF in the blood lead to more inflammation and persistent symptoms. These medications can alter a disease’s effect on the body by controlling inflammation in the joints, gastrointestinal tract, and skin.

There are six different TNF inhibitors that have been approved by the U.S. Food and Drug Administration for the treatment of rheumatic diseases. To decrease side effects and costs, most patients with mild or moderate disease may be treated with methotrexate before adding or switching to a TNF inhibitor. These agents can be used by themselves or in combination with other medications such as prednisone, methotrexate, hydroxychloroquine, leflunomide, or sulfasalazine.


Before taking the medicine

TNF inhibitors are usually held if the patient has high fever or is being treated with antibiotics for an infection. Once the infection goes away, the medication can be restarted.

Patients should talk to their doctor before getting any vaccinations while using an anti-TNF drug. Some vaccinations are safe, but live vaccines should be avoided.

These medications are expensive (more than $10,000 per year), but they are covered by most health care insurance plans. Copay amounts vary widely. Ask your doctor about prescription assistance plans that can help you to get the medication at a lower price or free of charge. Refer to the package insert for more information.


Side Effects

The most common side effect seen with the injectable drugs are skin reactions, commonly referred to as “injection site reactions.” The patients usually complain of a localized rash with burning or itching. These reactions can last up to a week. Infliximab has been associated with a severe allergic reaction with swelling of the lips, difficulty breathing and low blood pressure. Your doctor will usually order a pre-medication to decrease the chances of an infusion reaction.

The most significant side effect is an increased risk for all types of infections, including tuberculosis (TB) and fungal infections. Some of these infections may be severe. Patients should be tested for TB before starting therapy, because such an infection can worsen during treatment. The usual way of testing is with a skin test, but a blood test is also available.

Long-term use of TNF inhibitors may increase the risk of cancers such as lymphoma and skin cancer. There are rare neurologic complications as well. People who have a history of multiple sclerosis should not use them. People with significant heart failure should not use a TNF inhibitor, because their heart disease could worsen.


Keywords: anti-tumor necrosis factor drugs; anti-TNF drugs; TNF inhibitors.

* The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.