How Anti-TNF Treatments Work

Recently, we’ve discussed how specific biologic medications work.

Rituxan was the first medication presented and we also shared how Orencia (abatacept) works.   This was prompted by a patient asking me to express in writing what I verbally explain when someone is starting this medication.

This week we are featuring biologic therapies that reduce the inflammatory substance TNF (tumour necrosis factor).

Within our immune system are dendritic cells.  Their job is to survey the body and report any irregular cells or invaders, such as a virus or bacteria.  Unfortunately, in many autoimmune conditions (rheumatoid arthritis, ankylosing spondylitis,  psoriatic arthritis, psoriasis, Crohn’s and ulcerative colitis) , these cells generate an alert to the immune system which results in excess inflammation being made within specific tissues (joints, skin or the gut lining) where there is no infection.  In all these diseases, TNF (tumour necrosis factor) is made in large amounts leading to damage, which is irreversible.  The goal of anti-TNF biologics is to attach to TNF and remove it from the body, to prevent further damage and put the disease into a state of low disease activity if not remission.

As with all biologic medication, anti –TNF treatments are composed of protein and therefore cannot be swallowed or they would be digested in the stomach and destroyed. There are five anti-TNF therapies on the Canadian market.  Some of them are approved for multiple conditions and others for arthritic conditions only.

  • Adalimumab (Humira) – given every other week by injection.
  • Certolizimab (Cimzia)- given every other week or two injections monthly
  • Etanercept (Enbrel –originator, Brenzys /Eralzi – Biosimilar forms of etanercept- given weekly by injection
  • Golimumab (Simponi)- given monthly by injection or by infusion (rheumatoid arthritis only)
  • Infliximab (Remicade –originator, Inflectra/Renflexis – Biosimilar forms) given by infusion.

As with all biologics used in autoimmune conditions, the risk of infection is a little greater than in the general public and therefore updating adult vaccines is suggested.  Anti-TNF therapies are not given when someone is experiencing an active infection.  These treatments are used in caution in patients who have a demylinating disease (ie. multiple sclerosis) or congestive heart failure.

By lowering inflammation in blood vessels, anti-TNF therapies are considered protective against cardiovascular disease.


Carolyn Whiskin is the Pharmacy Manager for Charlton Health.  Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

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