From the Guidelines
Tumor Necrosis Factor-alpha (TNF-alpha) therapy is most required for moderate to severe rheumatoid arthritis, Crohn's disease, ulcerative colitis, ankylosing spondylitis, psoriatic arthritis, and severe plaque psoriasis that have not responded adequately to conventional treatments. These autoimmune and inflammatory conditions benefit from TNF-alpha inhibitors like adalimumab (Humira), infliximab (Remicade), etanercept (Enbrel), certolizumab pegol (Cimzia), and golimumab (Simponi) 1. Dosing varies by medication and condition - for example, adalimumab is typically administered as 40mg subcutaneously every other week for rheumatoid arthritis, while infliximab requires intravenous infusions of 3-5mg/kg at weeks 0,2, and 6, then every 8 weeks thereafter.
Key Conditions Requiring TNF-alpha Therapy
- Moderate to severe rheumatoid arthritis
- Crohn's disease
- Ulcerative colitis
- Ankylosing spondylitis
- Psoriatic arthritis
- Severe plaque psoriasis
These medications work by blocking TNF-alpha, a pro-inflammatory cytokine that drives inflammation and tissue damage in these conditions. Patients require pre-treatment screening for tuberculosis and hepatitis B, and should be monitored for infections, malignancies, and demyelinating disorders during therapy 1. TNF inhibitors are generally prescribed when conventional therapies like methotrexate, sulfasalazine, or corticosteroids have failed to control disease activity adequately, as they can dramatically improve symptoms and prevent disease progression in these challenging conditions. The most recent and highest quality study 1 supports the use of TNF-alpha inhibitors in these conditions, highlighting their efficacy across a broad range of immune-mediated inflammatory diseases.
Monitoring and Safety Considerations
- Pre-treatment screening for tuberculosis and hepatitis B
- Monitoring for infections, malignancies, and demyelinating disorders during therapy
- Avoidance of TNF inhibitors in patients with chronic, serious, or recurring infections
- Caution in patients with concomitant chronic hepatitis C infection, with consultation with liver specialists as needed and interval monitoring of serum aminotransferases and hepatitis C viral load.
From the FDA Drug Label
Lymphoma and Leukemia In the controlled portions of clinical trials of all the TNF-blockers in adults, more cases of lymphoma have been observed among TNF-blocker-treated patients compared to control-treated patients In the controlled portions of 39 global adalimumab clinical trials in adult patients with RA, PsA, AS, CD, UC, Ps, HS and UV, 2 lymphomas occurred among 7973 adalimumab-treated patients versus 1 among 4848 control-treated patients Patients with RA and other chronic inflammatory diseases, particularly those with highly active disease and/or chronic exposure to immunosuppressant therapies, may be at a higher risk (up to several fold) than the general population for the development of lymphoma, even in the absence of TNF blockers
The diseases that most require TNF-alpha therapy are:
- Rheumatoid Arthritis (RA)
- Psoriatic Arthritis (PsA)
- Ankylosing Spondylitis (AS)
- Crohn's Disease (CD)
- Ulcerative Colitis (UC)
- Psoriasis (Ps)
- Hidradenitis Suppurativa (HS) These diseases are mentioned in the context of TNF-blocker treatment, including adalimumab, in the provided drug label 2.
From the Research
Diseases Requiring TNF-alpha Therapy
The following diseases most require Tumor Necrosis Factor-alpha (TNF-alpha) therapy:
- Rheumatoid arthritis 3, 4, 5, 6, 7
- Crohn's disease 3, 4, 5, 6, 7
- Psoriatic arthritis 3, 4, 5, 6, 7
- Ankylosing spondylitis 3, 4, 5, 6, 7
- Ulcerative colitis 3, 4, 5, 6, 7
- Severe chronic plaque psoriasis 3
- Juvenile idiopathic arthritis 4
- Spondyloarthritis 4
- Chronic endogenous uveitis 5
TNF-alpha Inhibitors
Several TNF-alpha inhibitors are available for clinical use, including:
- Infliximab 3, 4, 5, 6, 7
- Adalimumab 3, 4, 5, 6, 7
- Etanercept 3, 4, 5, 7
- Golimumab 4, 5, 7
- Certolizumab pegol 4, 5, 7
Adverse Reactions
The most commonly reported adverse reactions to TNF-alpha inhibitors include: