Understanding Ankylosing Spondylitis Medications (cont.)
Tumor Necrosis Factor Alpha Antagonist Medications (TNF Inhibitors)
Drugs in this class include etanercept
(Enbrel), infliximab (Remicade), adalimumab (Humira), and golimumab (Simponi).
- How TNF inhibitors work: These agents inhibit key factors responsible for inflammatory responses in the immune system. Etanercept, infliximab, adalimumab, and golimumab are tumor necrosis factor (TNF) antagonists. TNF is a naturally occurring chemical which promotes inflammation in the body. TNF antagonists block TNF and therefore decrease inflammation.
- Who should not use these medications: People with severe heart failure, an active infection, sepsis, or active tuberculosis should not take the drug. Patients with a skin test positive for tuberculosis or a history of histoplasmosis should undergo treatment to reduce the reactivation of these infections.
- Use: Etanercept is taken as a subcutaneous (under the skin) injection once or twice a week. Adalimumab is taken as an injection twice a month. Golimumab is taken as an injection once a month. Infliximab is taken as a two hour intravenous infusion. This may be given in a doctor's office, the hospital, or another outpatient facility. It is infused every
eight weeks, after more frequent doses initially. All of the TNF inhibitors may be used alone or with methotrexate or sulfasalazine.
- Drug or food interactions: TNF inhibitors may increase infection risk or decrease blood cell counts when used with other immune modulators or immunosuppressant drugs (for example, anticancer agents, corticosteroids). Immunization with some vaccines may not be effective.
- Side effects: TNF inhibitors must be used with caution in people with heart failure or impaired kidney function. If a serious infection develops, the drug must be discontinued. Exacerbation of tuberculosis, infection with unusual organisms, and the rare development of drug-induced lupus are other rare but serious side effects.
The following are other possible adverse effects:
- Etanercept, adalimumab and golimumab sometimes cause injection site pain, redness, and swelling.
- Reactions to the intravenous infusion of infliximab may occur such as shortness of breath and hives.
- Cold or flu symptoms
- Stomach upset