For patients · Medication guide

TNF inhibitors

anti-TNF, adalimumab, etanercept, infliximab, certolizumab, golimumab

Are you a clinician? See the clinical version of this page.

The short versionTNF inhibitors are a type of biologic medicine. They block a specific signal called TNF that drives inflammation. They are used when disease-modifying tablets are not enough in rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis, and they can help the joints, the spine, the tendons, and the skin.

How you take it

These are biologic medicines given by injection under the skin (or, for infliximab, by a drip into a vein at the clinic). They lower inflammation by blocking TNF, a signal that drives joint swelling. Which one you use and how often depends on the specific drug, and they are often combined with methotrexate.

Adalimumab (Humira and biosimilars): An injection under the skin every 2 weeks.
Etanercept (Enbrel and biosimilars): An injection under the skin once a week.
Certolizumab pegol (Cimzia): Loading injections, then an injection every 2 to 4 weeks.
Golimumab (Simponi): An injection under the skin once a month, or an IV infusion.
Infliximab (Remicade and biosimilars): A drip into a vein at the clinic, spaced to about every 8 weeks after the first few.

Tests while you take it

Before starting, you are checked for hidden infections such as tuberculosis and hepatitis. Tell your team promptly about fevers or signs of infection.

What to know

Common side effects

The most common effects are reactions where the injection is given, such as redness or soreness. Because they calm part of the immune system, they can make infections more likely, so it helps to watch for and treat infections early.

Tests and monitoring

Before you start, your team checks for hidden infections such as tuberculosis, and for hepatitis if you have risk factors, and does some baseline blood tests. It also helps to be up to date with recommended vaccines beforehand, and live vaccines are usually avoided while you are on treatment. While on treatment, tell your team about any infection that does not settle.

Important cautions

These medicines are used with care if you have had certain infections, some heart conditions, or some nervous system conditions. Tell your team before any live vaccine or planned surgery, and let them know promptly about new infections.

+Planning a pregnancy? This medicine has separate, reviewed reproductive-health guidance. See the pregnancy guide for this medicine.

iThis page helps you prepare a conversation with your care team. It does not replace individual medical advice. Always confirm your own plan with your rheumatology team.

What to watch for

Signs of infection with a fever, or an infection that does not clear. Contact your team.
A new cough, night sweats, or weight loss, which should be checked.
New breathlessness or swelling of the legs.
A severe reaction during or soon after an infusion, which needs urgent care.