Anti-tumour necrosis factor (TNF) medicines

Understanding TNF inhibitors

Conventional disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate and sulfasalazine, were the only treatments available prior to anti-TNF (or biologics). These conventional treatments did not always work for everyone either on their own or in combination with other medications. In the 1990’s Versus Arthritis helped to fund research into other treatments.

Anti-TNF medications were designed to treat inflammatory arthritis by acting directly on the disease itself. Biologic therapies are currently given to patients whom have already tried appropriate treatments for their condition and have not responded well to them.

Before starting medication

Please read the information and watch the videos on TNF inhibitors before starting this medication. It is important you understand how this medications works and why it is being prescribed; as well as how to take the medication correctly.

Answering some of your questions about TNF inhibitors

Medications and delivery service

Please note: on rare occasions brands can change depending on allocation of resources but you would be informed in advance.

  • Etanercept (Benepali): administered once a week; delivered via Healthnet
  • Adalimumab (Amgevita): administered every 2 weeks; delivered via Sciensus
  • Certilizumab (Cimzia): administered every 2 weeks (this has a loading dose of 400mg (2x200mg) week 0,2 and 4 then 200mg every 2 weeks); delivered via Sceinsus
  • Golimumab (Simponi): administered once a month on the same date each month; delivered via Sciensus
  • Infliximab (Remsema): this is given as an infusion on our day case until every 4 to 8 weeks depending on need; it is now available as an injection but for some conditions it requires a loading dose of a few IV infusions at first, but the nurse will discuss this with you in more detail

It can take 4-5 weeks for the account to be put in place and for the delivery to arrive. Once the injections have been delivered, place them in the fridge. Nurse training is arranged via the delivery company.

Medication is issued through rheumatology, not your GP. The delivery company will contact you to arrange a date and time.

A nurse from the same company should offer 2 training visits to teach you how to self-inject.

The injections must be stored in the fridge. One dose per pen/syringe.

The delivery company will provide a sharps bin once you have injected the pen/syringe place it in the bin provided.

Homecare delivery service

What is a homecare medicines service?

  • A homecare medicines service is the delivery of hospital prescribed medicines directly to your home or other appropriate location
  • Your hospital team is still fully responsible for the clinical aspects of your treatment.

How will a Homecare Medicines Service benefit me?

  • Home delivery – no waiting in outpatients for prescriptions
  • Repeat prescriptions are automatically ordered and arranged by the hospital

How will my medicines be delivered?

  • Deliveries are made by a homecare delivery driver
  • The driver carries official identification which you can ask to see

What can I do to help?

  • Attend your appointments and blood tests
  • Make sure we and the homecare company have your up to date contact details
  • Make sure someone is around for when your delivery is due
  • Store your medicines correctly
  • Inform the homecare company if you need to make any changes to the delivery date or nurse visit
  • Check your delivery when it arrives
Pregnancy and breastfeeding

Seek advice from your consultant or nurse before planning a family.

The British Society of Rheumatology (2022) guidelines recommend stopping TNF medication is those with low disease activity or low risk of flaring at:

  • Infliximab at 20 weeks
  • Adalimumab and Golimumab at 28 weeks
  • Etanercept at 32 weeks
  • Certolizumab (Cimzia) is safe throughout pregnancy

Those with active or poorly controlled disease can continue anti-TNFs throughout pregnancy but live vaccines have to be avoided in infants until 6 months of age. With the exception of Certolizumab which does not require any alternations to the infant vaccination schedule.

Anti-TNFs are compatible with breastfeeding, although data is limited.

Men do not need to stop anti-TNFs when trying for a family, although again data is limited.

Your team will advise accordingly – let us know in plenty of time!

When to attend for blood monitoring

Blood monitoring after your first injection is month 1, month 3 then every 3 months. If stable, it can be extended to every 6 months; unless taken in combination with methotrexate – then remain on every 3 months once stable.

We will only contact you if the results are abnormal.

It is important to attend for blood tests to ensure it is safe to continue the drug. No bloods, no medication. Safe prescribing is a priority.

You will have to book your own blood test. To book a blood test at St Luke’s Hospital, please ring 01274 365056 or 01274 365170 to make an appointment. Alternatively, you can book your own blood test appointment. Phone lines are open Monday to Friday between 8.30am and 4pm.

General advice

Limit alcohol and avoid binge drinking. Do you know your safe limits? Learn more on NHS.UK – Alcohol units.

Avoid live vaccines. This includes, but is not limited to, rabies, MMR, yellow fever and some forms of shingles vaccine. You should advise any travel clinic that you are taking immunosuppression.

Flu, Covid and Pneumonia vaccines are inactive vaccines – this means they are not live vaccines. Your GP will call you for these vaccines and we strongly advise that you have these.

Read more about vaccinations (Versus Arthritis).

Avoid contact with chickenpox. (As adults we tend to develop shingles rather than chicken pox, you may require anti-viral treatment from your GP).

Prevent sunburn. (Check for changes in the skin and monitor freckles and moles for such as changes in size, shape, colour and weeping). Have any changes checked with your GP.

Sunburn can lead to skin damage which increases the risk of developing skin cancers. We recommend “slip, slap, slop” – slip on a shirt to cover up, slap on a hat, slop on the sunscreen. Find out more on NHS.UK – Sunscreen and sun safety.

Useful links
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