What is the relationship betweenTNF(tumor necrosis factor) and infection? Is there any case in which a patient’s medical history or clinical symptoms would preclude prescribingTNF blockers? Also, is there any time when these drugs should be discontinued or even temporarily discontinued, such as if a patient has a cold, flu, infection, or upcoming surgery?
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Side Effects of TNF Blockers
TNF blockers are a very effective treatment forrheumatoid arthritis. Like all medications, however, there are potential side effects.
In particular, the five TNF blockers—Enbrel (etanercept), Humira (adalimumab), Remicade (infliximab), Simponi (golimumab), and Cimzia (certolizumab pegol)—increase the risk for development oftuberculosis(TB). The reason this occurs is that tumor necrosis factor (TNF) plays a crucial role in the body’s immune defense against the mycobacteria that cause TB.
As a result, it is recommended that doctors screen patients with a TB skin test prior to starting treatment with a TNF blocker. If there is evidence of prior exposure (a raised red area will develop within two to three days at the site of the skin test), a medication can be given in combination with the TNF blocker to allow treatment.
Recommendations
Despite good clinical outcomes in people with rheumatoid arthritis,concerns remainbecause, typically, the healthiest patients are entered into clinical studies, and many cases of infection are not reported once the drug is on the market. Here’s the bottom line:
Scott J. Zashin, M.D. said, “Whether to discontinue therapy in patients with minor infections is unclear, but I typically recommend avoiding treatment, as I do not feel the benefits of continuing treatment during infection outweigh the risks. With elective surgery, there are no recommendations from the companies as to whether to temporarily stop treatment. There is limited and conflicting data on the effect of TNF blockers on surgical outcomes. In most cases, I recommend stopping Enbrel 1-2 weeks before surgery, and resume 1 week later, if there are no signs or symptoms of infection. Humira should be stopped 2 weeks before and resumed 1 week after. Remicade should be stopped 4 weeks before and resumed 10 days to 4 weeks after surgery.”
Note: Please consult your physician for advice on whether you must temporarily stop Enbrel, Humira, Remicade, Simponi, or Cimzia prior to surgery. Individual physicians may have different requirements.
SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, phone interview.
Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, phone interview.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, phone interview.
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