What is this medication for?

Anti-Tumor Necrosis Factor alpha (anti-TNFα) belongs to a class of medications called biologics or more specifically, biological disease modifying anti-rheumatic drugs (bDMARD).

Biologics work by blocking targeted parts of the immune system that cause inflammation in the body.

Anti-TNFα targets and blocks the effect of TNF. This reduces inflammation and flares, improves symptoms and quality of life, and prevents disease progression.

There are many anti-TNFα drugs available including adalimumab, certolizumab, etanercept, golimumab and infliximab. It may be used alone (monotherapy) or together with other DMARDs.

Biologics are more costly compared to conventional DMARDs. Your doctor may discuss with you if there is a biosimilar (non-branded version of the original biologic) which works the same way as biologics at a more affordable cost.

How should I take/use this medication?

• It may be given as

  • subcutaneous injection (inject under the skin, into areas like the abdomen or thigh) such as adalimumab and golimumab. This can be injected by yourself or a caregiver at home.

  • intravenous infusion (inject into the blood vessel) such as infliximab. This has to be done in the hospital for typically 2 to 4 hours.

• Do not stop using your medication without checking with your healthcare professional.

• Other medications such as corticosteroids (e.g. prednisolone) or disease modifying anti-rheumatic drugs (DMARDs) may be taken with anti-TNFα.

What should I do if I forget to take/use this medication?

Different biologics have different intervals between doses. If you forget to inject a dose, do it as soon as you remember. Then inject your next dose at the usual time. Do not administer two doses to make up for the missed dose. DO check with your healthcare professional if unsure.

If you miss your infusion appointment, book another appointment as soon as possible. Inform your doctor about the missed/ late dose.

What precautions should I take?

Inform your healthcare professional if:

• You are allergic to this medication or any of the other ingredients of this medication.

• You plan to start a family or to breastfeed. Certain biologics may be safer than others in pregnancy.

• You are taking any other medications, including over-the-counter medicines, supplements, traditional medications and herbal remedies.

• You have any heart problems. Your doctor may want to monitor your heart condition more closely after starting anti-TNFα.

Avoid overcrowded places and stay away from people who are sick to prevent getting an infection.

Reactivation of infections such as tuberculosis (TB) and hepatitis B may happen when you are on this medication, hence, your doctor will check for such infections before starting anti-TNFα.

What are some common side-effects of this medication?

• Infection (common cold, sinusitis, urinary tract infections and skin infections)

  • If you develop a fever, sore throat, pain on urination or feel generally unwell, see a doctor immediately. Tell the doctor whom you consult that you are on anti-TNFα.

• Injection site reactions: symptoms include bruising, redness, itching, pain and swelling

  • If you are using subcutaneous injection, rotate the injection site each time. You may also apply a cold pack to the injection site after injection.

  • These symptoms are temporary and usually go away within 3 to 5 days.

• Infusion reactions: symptoms include flushing, chills, chest tightness, shortness of breath, hypotension or hypertension

  • Medications may be given before the infusion to prevent these reactions.

  • You will be monitored closely in the ward during and after the infusion

    • Inform the nurse immediately if you experience any of these symptoms.

    • Your infusion may be slowed down or stopped if the symptoms are severe.

• Low blood cell count (platelet, red and/or white blood cell)

• Headache

• Rash

It is important to monitor the effects of your new treatment, particularly during the first few months of treatment. If the symptoms persist or are severe, consult your doctor. You may need to have regular blood tests to monitor your blood counts while on this medication.

What are some rare but serious side-effects that I need to seek medical advice immediately?

The symptoms of a drug allergy include one or more of the following:

• Swollen face/eyes/lips/tongue

• Difficulty in breathing

• Itchy skin rashes over your whole body

Some rare but serious side effects include:

• Severe infections such as pneumonia, fungal infection, reactivation of tuberculosis and hepatitis B

• Combined low blood cell count (symptoms include infection, persistent fever, feeling very tired or weak, bleeding/bruising very easily, looking pale)

• Lung inflammation 

• Severe muscle weakness/numbness/tingling sensation

• Seizures

• Heart problems (symptoms include shortness of breath with exertion or on lying down, swelling of feet)

If you experience any of these symptoms, you should stop your medication and see your healthcare professional immediately.

Long term use of anti-TNFα may increase the risk of lymphoma and other cancers. However, this is very rare. You may also be at higher risk if you are also taking certain medications that suppress the immune system. Your doctor will monitor/manage this risk closely.

What food or medication should I avoid when I take this medication?

• Avoid eating raw, undercooked or half-cooked food.

• Live vaccines such as MMR (measles, mumps and rubella), OPV (oral polio vaccine), yellow fever or BCG (tuberculosis). Discuss with your doctor before receiving any vaccines. Also, direct contact with persons who have taken oral polio vaccine or those with infections should be avoided. However, Pneumococcal, influenza (flu) and Hepatitis B vaccinations are safe and may be given if required.

How should I store this medication?

Store in the refrigerator between 2-8◦C and protected from light. Do not freeze. Keep this medication away from children.

How should I throw away this medication safely?

Pack this medication into a black trash bag and seal it tightly before throwing into the rubbish chute or bin. Dispose needles in a sharps box or tightly closed container to avoid needle prick injury.

Disclaimers

If you take more than the recommended dose, please seek medical advice immediately. The information provided on this page does not replace information from your healthcare professional. Please consult your healthcare professional for more information.

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.

Last updated on Oct 2022