How Do TNF Inhibitors (DMARDs) Work?

Tumor necrosis factor(TNF) inhibitors (DMARDs) belong to a class of medications known as disease-modifying anti-rheumatic drugs (DMARDs). TNF inhibitors are prescribed in the treatment of severalautoimmuneinflammatory disorders including arthritic,dermatologicandgastrointestinaldiseases.

TNF inhibitors are lab-manufactured biologic products that suppress inflammation by blocking the activity oftumor necrosis factor-alpha(TNF-A), a protein (cytokine) that plays a central role in promoting persistent inflammation in autoimmune disorders.

TNF-A is produced by immune cells such as phagocytes to destroy the infection. TNF-A activity is normally well controlled in healthy people, but in autoimmune disorders, dysfunctional TNF-A causes persistent inflammation and tissue damage in many parts of the body including joints, skin,gastrointestinal tract, and other organs.

TNF-A binds to special molecules known as TNF receptors (TNFRI and TNFRII) in cell membranes to activate inflammatory signals and release otherproinflammatorycytokines. TNF inhibitors bind to TNF-A and prevent its binding to the receptors and consequently, prevent the activation of inflammatoryimmune response.

TNF inhibitors (DMARDs) may be administered as subcutaneous injections in the tissue under the skin, or as intravenous injections or infusions to treat autoimmune inflammatory disorders that include:

FDA-approved:

• Rheumatoid arthritis(joint inflammation)
• Juvenileidiopathicarthritis(childhoodarthritis with no known cause)
• Polyarticular juvenile idiopathic arthritis (arthritis in more than four joints)
• Spondyloarthritis(关节炎病情的一个家庭s that affect the spine, other joints, bowel, skin, and eyes)
• Plaque psoriasis(skin condition with scaly lesions)
• Psoriatic arthritis(acomplicationofpsoriasis)
• Ankylosing spondylitis(a type of arthritis that causes thevertebraein the spine to fuse over time)
• Crohn’s disease (an inflammatory bowel disease)
• Pediatric Crohn’s disease
• Ulcerative colitis(an inflammatory bowel disease)
• Hidradenitis suppurativa (inflammation of hair follicles and sweat glands causing abscesses)
• Uveitis (inflammation of the uvea, the middle layer of the eye)

Orphan designation:

• Behcet’s disease (inflammation of blood vessels)
• Idiopathicpulmonary fibrosis(scarring of thelungs)

Side effects of TNF inhibitors (DMARDs) may include the following:

• Upper respiratory infections
• Non-upper respiratory infections
• Nasopharyngitis (inflammation of nose and throat)
• Pharyngitis(inflammation of the throat)
• Laryngitis(inflammation of thelarynx/voice box)
• Rhinitis(inflammation of thenasal passage)
• Sinusitis(inflammation of the sinuses)
• Bronchitis(inflammation of the bronchial passage)
• Cough
• Development of antinuclear antibodies
• Headache
• Injection site reactions such as:
  • Erythema(redness)
  • Induration(hardening of the skin)
  • Pain
  • Bruising
  • Irritation
  • Paresthesia(prickling sensation)
• Infusion-related reactions
• Skin reactions such
  • Rash
  • Urticaria(hives)
  • Pruritus(itching)
  • Skin exfoliation
  • Bullousreactions (blisters)
  • Linear IgA bullousdermatosis(an autoimmune skin disease)
  • Erythema multiforme(round lesions like a bullseye)
  • Cutaneousvasculitis(inflammation of blood vessels in the skin and the tissue beneath the skin)
  • Cutaneouslupuserythematosus (an autoimmune skin condition)
  • Subcutaneousnodule
  • Stevens-Johnson syndrome(a rare medical emergency with flu-like symptoms and a painful rash)
  • Lichenoid skin reaction (lichen planus-like eruptions)
  • Onset or worsening of psoriasis
  • Generalized exanthematouspustulosis(pustular eruptions)
  • Toxic epidermal necrolysis(a severe skin condition with widespread redness, skin cell death, and exfoliation which can lead tosepsis)
• Hypersensitivity reactions such as:
  • Alopecia(hair loss)
  • Angioedema(swelling in the tissue under the skin ormucousmembranes)
  • Laryngeal/pharyngeal edema (swelling up of throat)
  • Bronchospasm
  • Respiratory tract allergic reaction
  • Anaphylaxis(serious allergic reaction)
  • Anaphylactic shock
• Increase increatinephosphokinase (CPK)
• Development of antibodies to double-stranded DNA
• Elevated liver enzymesalanine aminotransferase(ALT) andaspartate aminotransferase(AST)
• Increase in alkaline phosphatase levels in the blood
• Nausea
• Diarrhea
• Dyspepsia(indigestion)
• Abdominal pain
• Constipation
• Serious infections
• Opportunistic infections such as:
  • Tuberculosis
  • Atypicalmycobacterial infection
  • Aspergillosis
  • Pneumocystisjirovecipneumonia
  • Protozoal infections
• Viral infections such asinfluenzaandherpes zoster
• Superficialfungal infections
• Candidiasis(Candidayeast infection)
• Bacterial infections
• Septicshock
• Bacterial arthritis
• Infectivebursitis(inflammation of abursa, fluid-filled sacs in joints)
• Abscess
• Urinary tract infection(UTI)
• Pyelonephritis(a type of kidney infection)
• Kidney/urinary disorder
• Hematuria(blood in the urine)
• Flulike syndrome
• Pyrexia (fever)
• Flushing
• Fatigue
• Back pain
• Arthralgia(joint pain)
• Chest pain
• Hyperlipidemia(high level of blood fats)
• Hypercholesterolemia(highcholesterollevels in the blood)
• Hypertension(high blood pressure)
• Cardiac disorder
• Pericardialeffusion
• Congestive heart failure
• Myocardialischemia(reduced blood supply to the heart muscles)
• Myocardial infarction(heart attack)
• Dyspnea(shortness of breath)
• Interstitiallung disease (a group of diseases such as pulmonary fibrosis that scar the lungs)
• Pulmonary embolism(blood clotin the lung)
• Lupus-like symptoms
• Blood disorders such as:
  • Leukopenia(low count of leukocyte immune cells)
  • Neutropenia(low blood count ofneutrophilimmune cells)
  • Agranulocytosis(lowgranulocytes, immune cells with granules)
  • Pancytopenia(low count of all types of blood cells)
  • Aplastic anemia(anemiadue to reduced red cell production)
  • Thrombocytopenia(lowplatelet count)
  • Idiopathic thrombocytopenicpurpura(easy bruising and bleeding due to thrombocytopenia)
  • Thrombotic thrombocytopenic purpura(a rare disorder that causesblood clotsto form in small blood vessels)
• Lymphatic system disorder
• Lymphadenopathy(swollen lymph nodes)
• Bonefracture
• Hepatitis(liver inflammation)
• Jaundice
• Cholestasis(blockage ofbilefluid flow)
• Liver failure
• Sarcoidosis(a disease that causes tiny collections of inflammatory cell growth)
• Benignneoplasms (tumors),cysts, and polyps
• Malignantgrowths including Merkel cellcarcinomaandmelanoma, types of skin cancer
• Cervicalcancer
• Hepatosplenic T-celllymphoma(一种罕见的没有n-Hodgkin lymphoma)
• Leukemia(a type of blood andbone marrowcancer)
• Macrophage activation syndrome (excessive activation of immune cells such as macrophages and T-cells)
• Oculardisorder
• Transient vision loss
• Lagophthalmos (inability to fully close the eyelids)
• Optic neuritis (inflammation of the optic nerve)
• Uveitis (inflammation of the uvea, the middle layer of the eye)
• Scleritis (inflammation of sclera, the white layer of the eye)
• Convulsions
• Seizure
• Transversemyelitis (inflammation of thespinal cord)
• Demyelination (loss of myelin, the fatty tissue that protects nerve cells)
• Neurologicaldisorders caused by demyelination, such as:
  • Guillain-Barre syndrome
  • Multiple sclerosis
  • Chronic inflammatory demyelinating polyneuropathy
  • Multifocalmotorneuropathy
• Cerebrovascular accident
• Systemic vasculitis
• Deep vein thrombosis(DVT)
• Diverticulitis(inflammation of diverticula, small pouches that develop in the bowels) and an associated bowel perforation
• Appendicitisand associated perforations
• Pancreatitis(inflammation of the pancreas)
• Inflammatory bowel disease
• Anxiety
• Bipolar disorder
• Suicide attempt
• Menstrual disorder

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Genericand brand names of TNF inhibitors (DMARDs) include:

• Abrilada
• adalimumab
• adalimumab-adaz
• adalimumab-adbm
• adalimumab-afzb
• adalimumab-atto
• adalimumab-bwwd
• adalimumab-fkjp
• Amjevita
• Avsola
• certolizumab pegol
• Cimzia
• Cyltezo
• Enbrel
• Erelzi
• etanercept
• etanercept-szzs
• etanercept-ykro
• Eticovo
• golimumab
• Hadlima
• Hulio
• Humira
• Hyrimoz
• Inflectra
• 英夫利昔单抗
• 英夫利昔单抗-abda
• 英夫利昔单抗-axxq
• 英夫利昔单抗-dyyb
• 英夫利昔单抗-qbtx
• Ixifi
• Remicade
• Renflexis
• Simponi
• Simponi Aria