View source for Tumour necrosis factor-α inhibitors

== Background ==

* TNF-α is a cytokine involved in the inflammatory response to infection
* Has soluble and transmembrane forms
* Produced by macrophages, NK cells, granulocytes, fibroblasts, and T cells
* Receptors for TNF-α (TNFR1 and TNFR2) are found on most human cells, and are involved in cell activation and proliferation, cytokine production, and granuloma formation

== Medications ==

* [[Adalimumab]]
* [[Infliximab]]
* [[Certolizumab pegol]]
* [[Etanercept]]

== Contraindications ==

* Active bacterial infection, active tuberculosis or untreated LTBI, active herpes zoster infection, active invasive fungal infection, infected skin ulcers, acute hepatitis B or C, untreated chronic hepatitis B, or chronic hepatitis B or C with Child-Pugh B or C

== Safety ==

* Baseline [[TST]], ±CXR, prior to starting medications, with patients identified as having [[LTBI]] being offered prophylaxis
** Cutoff for TST is 5 mm
*Assess for [[hepatitis B prophylaxis]]

=== Adverse Effects ===

==== Infections ====

* Bacteria: [[septic arthritis]], [[Listeria monocytogenes]], [[Legionella]], [[Nocardia]], [[Actinomyces]], [[Salmonella]]
* Mycobacteria: [[Mycobacterium tuberculosis|'''Mycobacterium tuberculosis''']], [[Mycobacterium avium]], [[Mycobacterium bovis]], BCG
**Risk of TB is higher for [[infliximab]] and [[adalimumab]] compared to [[etanercept]]
* Fungi: [[Aspergillus fumigatus]], [[Histoplasma capsulatum|'''Histoplasma capsulatum''']], [[Coccidioides]], [[Cryptococcus neoformans]], [[Candida albicans]]
* Parasites: [[Toxoplasma gondii]]
* Viruses: [[hepatitis B virus|'''hepatitis B virus''']], [[hepatitis C virus]], [[varicella-zoster virus]]
* Screening prior to use should be done for [[LTBI]] (TST or IGRA), [[hepatitis B]], [[hepatitis C]], and [[HIV]]

[[Category:Immunocompromised hosts]]
[[Category:Rheumatology]]
[[Category:Medications]]