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Anti-Tumour Necrosis Factor (Anti-TNF)

Drug Class: Commonly Known As: Category:
Tumor Necrosis Factor Inhibitor Adult

Anti-Tumour Necrosis Factor (Anti-TNF) - What is it for

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

Biologics are small molecules that work by blocking targeted part of the immune system that cause an inflammation in the body. 

Anti-TNFα targets and block the effect of TNF. Thus, reduce inflammation, improve symptoms, reduce flare, stop disease from progressing and improve quality of life. 

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

Biologics are costly. Your doctor may discuss with you biosimilar which works the same way as biologics at more affordable cost.

Anti-Tumour Necrosis Factor (Anti-TNF) - Side Effects, Precautions, and Contraindications

What side effects can Anti-Tumour Necrosis Factor (Anti-TNF) cause?

  • Infection: symptoms include colds, sinusitis, urinary tract infections and skin infections
    • If you develop a fever, sore throat or feel generally unwell, see a doctor immediately. The doctor whom you consult should be told 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. 
  • 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.
  • 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. For your safety, you need to do regular blood tests for monitoring.

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, activation of tuberculosis and hepatitis B
  • Combined low blood cell count (symptoms include infection, feeling very tired or weak, bleeding)
  • Lung inflammation 
  • Severe muscle weakness
  • Seizures
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. You may be more at risk if you are also taking certain immunosuppressant. Your doctor will monitor you on any signs of cancer.

Before taking Anti-Tumour Necrosis Factor (Anti-TNF) , what precautions must I follow?

  • 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 are safer than other in pregnancy.
    • You are taking any other medications, including over-the-counter medicines, supplements, traditional medications and herbal remedies.
  • Avoid overcrowded places and stay away from people who are sick to prevent getting an infection.
  • Reactivation of infection such as tuberculosis (TB) and hepatitis B may happen when you are on medication, hence, your doctor will check for such infection before starting anti-TNFα.
  • If you have heart problems, as anti-TNFα may make your symptoms worse, therefore your doctor may monitor your heart closely before and after the treatment.

What food or medicine must I avoid when I take Anti-Tumour Necrosis Factor (Anti-TNF) ?

  • ​Avoid eating raw, undercooked or half-cooked food.
  • Pneumococcal and influenza (flu) vaccinations are safe and may be given if required. Avoid 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.

Anti-Tumour Necrosis Factor (Anti-TNF) - Dosage and How to Use

How should Anti-Tumour Necrosis Factor (Anti-TNF) be used?

  • It may be given as: 
    • subcutaneous injection (inject under the skin, into the abdomen or thigh) such adalimumab and golimumab. This can be done by self 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 taking 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 miss a dose?

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 take two doses to make up for the missed dose. 

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

What should I do if I overdose?

Anti-Tumour Necrosis Factor (Anti-TNF) - Handling

How should I handle Anti-Tumour Necrosis Factor (Anti-TNF) safely?

Anti-Tumour Necrosis Factor (Anti-TNF) - Storage

How should I store Anti-Tumour Necrosis Factor (Anti-TNF) ?

;#Keep away from children;#Keep in a cool, dry place, away from direct sunlight;#Store in the refrigerator. Do not freeze.;# After injection, dispose needles in a sharp disposal box. When the box is full, return it to pharmacy or clinic.

How should I dispose of Anti-Tumour Necrosis Factor (Anti-TNF) safely?

Anti-Tumour Necrosis Factor (Anti-TNF) - Additional Information

  • Updated on 12/31/2022 12:00:00 AM
  • Article contributed by PSS National Medication Information Workgroup PSS National Medication Information Workgroup
The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth


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