Table of ContentsView AllTable of ContentsHow They WorkEnbrelRemicadeHumiraCimziaSimponiBiosimilars
Table of ContentsView All
View All
Table of Contents
How They Work
Enbrel
Remicade
Humira
Cimzia
Simponi
Biosimilars
Tumor necrosis factor (TNF) inhibitors, sometimes called TNF-alpha or TNFα inhibitors, are medications that help reduce the inflammatory process in the treatment of autoimmune and inflammatory conditions. These medications include Enbrel (etanercept), Remicade (infliximab), Humira (adalimumab), Cimzia (certolizumab pegol), and Simponi (golimumab).
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How TNF Inhibitors Work
TNF inhibitors arebiologics, a class of drugs that are created from living cells. Earlier biologics were derived using rodent cells, but newer ones come from lab-created versions of human cells and are called “fully humanized.” This process createsmonoclonal antibodies, which areantibodiesthat have been cloned.
TNF inhibitors are not a first-line treatment for treating RA. They can be prescribed as a replacement for adisease-modifying anti-rheumatic drug (DMARD)that isn’t working well enough, and they can also be taken along with a DMARD, such as methotrexate. Current American College of Rheumatology guidelines for RA state that after maximal methotrexate therapy, either a biologic or a synthetic DMARDJAK inhibitor, like Xeljanz (tofacitinib) should be added.
When talking to your healthcare provider aboutwhich TNF inhibitor may be right for you, you may want to consider factors such as administration, side effects, and costs.
All TNF inhibitors come with a boxed warning, the FDA’s most serious warning, due to an increasedrisk of severe infectionand some types of cancer.
Administration
For plaque psoriasis, Enbrel is started at 50 mg twice a week for three months, after which it changes to the standard schedule.
Pediatric dosage is based on weight and is 0.8 mg per kilogram (kg)—about 2.2 pounds—per week, not to exceed a maximum of 50 mg.
Side Effects and Warnings
Common side effects of Enbrel include:
Less common, but more serious side effects are:
Enbrel may also increase your risk of some serious conditions, including several types of cancer,hepatitis B, and additional autoimmune diseases. If you have heart disease, Enbrel may make it worse.
Who Shouldn’t Take Enbrel
Don’t start Enbrel if you have a serious infection.
Enbrel may be harmful to people with certain conditions.
This drug is not recommended for people who:
Cost
Online retail estimates for Enbrel range from about $5,000 to nearly $9,000 per month. Amgen, the manufacturer, offers aco-pay cardfor people with insurance and aspecial programthat allows qualifying people without insurance to get the drug for free.
Remicade (infliximab) is a monoclonal antibody created with a combination of mouse and human cells. It joined Enbrel on the market after gaining FDA approval in 1999.
Remicade is given as an infusion at a healthcare provider’s office, hospital, or clinic. It’s delivered slowly through an intravenous (IV, in a vein) line, which usually takes two hours or longer.
After your first infusion, you’ll get another in two weeks, another four weeks later, and then go on a maintenance schedule of infusions every eight weeks. It can be given as frequently as every 4 weeks for patients that have an incomplete response.
Your healthcare provider will determine the proper dosage for your infusions.
Side Effects & Warnings
Common side effects of Remicade include:
In rare cases, more serious side effects have been reported, such as:
Who Shouldn’t Take Remicade
If you have any of the following conditions, you may not be a good candidate for Remicade:
Also, let your healthcare provider know if you’ve had any recent vaccinations.
Online estimates for a single dose of Remicade range from $1,300 to $2,500, plus the cost of the infusion procedure itself. The manufacturer, Janssen, offersprograms to help you cover the costs, whether or not you’re insured.
Humira (adalimumab), approved in 2002, was the first fully-humanized monoclonal antibody.
You inject yourself under the skin with Humira. It’s available in a pre-filled syringe or injector pen.
For some conditions, you’ll start with a higher and/or more frequent initial dose, then transition to the standard dose that’s recommended for your condition.
Common Humira side effects include:
More serious reactions include:
Who Shouldn’t Take Humira
If you have a demyelinating disease, such as multiple sclerosis, Humira might make it worse.
You shouldn’t start Humira if you have an active infection or have a high risk of infection due to uncontrolled diabetes or other health problems.
This drug isn’t recommended during pregnancy or lactation.
As with all TNF inhibitors, you should not take Humira if you have cancer.
Online estimates for Humira costs are around $5,800 dollars per month (two doses). Manufacturer AbbVie offersprograms to helpyou pay for the drug.
Cimzia (certolizumab pegol) is a fully-humanized monoclonal antibody approved in 2008.
Cimzia is a self-injected drug that typically starts out with an initial dose that’s higher than the maintenance dose.
For most indications, you start out with two separate injections of 200 mg each. You take the same amount two weeks later and two weeks after that. Your maintenance dose will then be either 200 mg every 14 days or 400 mg every 28 days.
Common side effects of Cimzia include:
Less often, the drug may cause severe side effects, including:
Who Shouldn’t Take Cimzia
Certain conditions could make this drug more dangerous for you.
You and your healthcare provider will need to discuss the pros and cons of Cimzia if you have:
You may need to delay starting Cimzia if you recently had alive vaccine.
Online estimates for Cimzia range from around $4,500 to $7,200 for a single 200-mg dosage. UBC, the manufacturer, offersprograms to helpcover the cost.
Simponi (golimumab) is a fully-humanized monoclonal antibody. The FDA granted it approval in 2009.
Simponi is self-injected under the skin. For most conditions, the standard dose is 50 mg once a month. For ulcerative colitis, there’s a higher initial dose and a maintenance dose of 100 mg every eight weeks.
A different formulation of this drug, Simponi Aria, is given as an infusion at a healthcare provider’s office, hospital, or clinic. After the first infusion, you’ll get a dose every eight weeks thereafter. Each infusion should last about 30 minutes.
Common side effects of Simponi include:
More serious complications of the drug include:
You shouldn’t get live vaccines while taking Simponi.
Who Shouldn’t Take Simponi
You shouldn’t start taking Simponi while you have an active infection.
You should carefully weigh the pros and cons of this drug with your healthcare provider if you’ve previously had hepatitis B or have recently had a live vaccine.
Online cost estimates for Simponi range from about $4,500 to $7,700. Janssen, the manufacturer, has aprogram designed to helpyou pay for the medication.
Guide to Taking Simponi
Saving Money on TNF InhibitorsIn addition to exploring pharmaceutical company programs for offsetting patients' drug costs, your healthcare provider or a hospital social worker may be able to guide you to other resources that can help you afford your medication(s).
Saving Money on TNF Inhibitors
In addition to exploring pharmaceutical company programs for offsetting patients' drug costs, your healthcare provider or a hospital social worker may be able to guide you to other resources that can help you afford your medication(s).
Biosimilars are typically less expensive than biologics. A pharmacy can’t substitute a biosimilar for the reference product. If you want the biosimilar, you have to get a prescription specifically for it.
If you’ve been prescribed a biologic but would rather take a biosimilar for financial or other reasons, you’ll need to get a whole new prescription for it. Speak with your healthcare provider.
BIOLOGICAVAILABLEBIOSIMILARSEnbrel•Erelzi (etanercept-szzs) •Eticovo (etanercept-ykro)Remicade•Avasola (infliximab-axxq) •Inflectra (infliximab-dyyb) •Ixifi (infliximab-qbtx) •Renflexis (infliximab-abda)Humira•Abrilada (adalimumab-afzb) •Amjevita (adalmimumab-atto) •Cyltezo (adalimumab-adbm) •Hadlima (adalimumab-bwwd) •Hulio (adalimumab-fkjp) •Hyrimoz (adalimumab-adaz)CimziaNoneSimponiNoneBiosimilars vs. Biologics for Treating Psoriatic Disease
Biosimilars vs. Biologics for Treating Psoriatic Disease
12 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.Farrugia M, Baron B.The role of TNF-α in rheumatoid arthritis: a focus on regulatory T cells.J Clin Transl Res. 2016;2(3):84-90.ACR Guidelines.Rheumatoid arthritis.U.S. Food and Drug Administration: AccessData.Enbrel: Highlights of prescribing information and Full Prescribing Information.U.S. Food and Drug Administration: FDA AccessData.Remicade: Highlights of prescribing information and Full prescribing information.National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Infliximab injection.U.S. Food and Drug Administration: FDA AccessData.Humira: Highlights of prescribing information and Full prescribing information.National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Adalimumab injection.Sator P.Safety and tolerability of adalimumab for the treatment of psoriasis: a review summarizing 15 years of real-life experience.Ther Adv Chronic Dis. 2018;9(8):147–158. doi:10.1177/2040622318772705U.S. Food and Drug Administration: FDA AccessData.Cimzia: Highlights of prescribing information and Full prescribing information.National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Certolizumab injection.U.S. Food and Drug Administration: FDA AccessData.Simponi: Highlights of prescribing information and Full prescribing information.National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Golimumab injection.Additional ReadingU.S. Food and Drug Administration.Information on tumor necrosis factor (TNF) blockers (marketed as Remicade, Enbrel, Humira, Cimzia, and Simponi).
12 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.Farrugia M, Baron B.The role of TNF-α in rheumatoid arthritis: a focus on regulatory T cells.J Clin Transl Res. 2016;2(3):84-90.ACR Guidelines.Rheumatoid arthritis.U.S. Food and Drug Administration: AccessData.Enbrel: Highlights of prescribing information and Full Prescribing Information.U.S. Food and Drug Administration: FDA AccessData.Remicade: Highlights of prescribing information and Full prescribing information.National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Infliximab injection.U.S. Food and Drug Administration: FDA AccessData.Humira: Highlights of prescribing information and Full prescribing information.National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Adalimumab injection.Sator P.Safety and tolerability of adalimumab for the treatment of psoriasis: a review summarizing 15 years of real-life experience.Ther Adv Chronic Dis. 2018;9(8):147–158. doi:10.1177/2040622318772705U.S. Food and Drug Administration: FDA AccessData.Cimzia: Highlights of prescribing information and Full prescribing information.National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Certolizumab injection.U.S. Food and Drug Administration: FDA AccessData.Simponi: Highlights of prescribing information and Full prescribing information.National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Golimumab injection.Additional ReadingU.S. Food and Drug Administration.Information on tumor necrosis factor (TNF) blockers (marketed as Remicade, Enbrel, Humira, Cimzia, and Simponi).
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.
Farrugia M, Baron B.The role of TNF-α in rheumatoid arthritis: a focus on regulatory T cells.J Clin Transl Res. 2016;2(3):84-90.ACR Guidelines.Rheumatoid arthritis.U.S. Food and Drug Administration: AccessData.Enbrel: Highlights of prescribing information and Full Prescribing Information.U.S. Food and Drug Administration: FDA AccessData.Remicade: Highlights of prescribing information and Full prescribing information.National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Infliximab injection.U.S. Food and Drug Administration: FDA AccessData.Humira: Highlights of prescribing information and Full prescribing information.National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Adalimumab injection.Sator P.Safety and tolerability of adalimumab for the treatment of psoriasis: a review summarizing 15 years of real-life experience.Ther Adv Chronic Dis. 2018;9(8):147–158. doi:10.1177/2040622318772705U.S. Food and Drug Administration: FDA AccessData.Cimzia: Highlights of prescribing information and Full prescribing information.National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Certolizumab injection.U.S. Food and Drug Administration: FDA AccessData.Simponi: Highlights of prescribing information and Full prescribing information.National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Golimumab injection.
Farrugia M, Baron B.The role of TNF-α in rheumatoid arthritis: a focus on regulatory T cells.J Clin Transl Res. 2016;2(3):84-90.
ACR Guidelines.Rheumatoid arthritis.
U.S. Food and Drug Administration: AccessData.Enbrel: Highlights of prescribing information and Full Prescribing Information.
U.S. Food and Drug Administration: FDA AccessData.Remicade: Highlights of prescribing information and Full prescribing information.
National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Infliximab injection.
U.S. Food and Drug Administration: FDA AccessData.Humira: Highlights of prescribing information and Full prescribing information.
National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Adalimumab injection.
Sator P.Safety and tolerability of adalimumab for the treatment of psoriasis: a review summarizing 15 years of real-life experience.Ther Adv Chronic Dis. 2018;9(8):147–158. doi:10.1177/2040622318772705
U.S. Food and Drug Administration: FDA AccessData.Cimzia: Highlights of prescribing information and Full prescribing information.
National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Certolizumab injection.
U.S. Food and Drug Administration: FDA AccessData.Simponi: Highlights of prescribing information and Full prescribing information.
National Institutes of Health, U.S. National Library of Medicine: MedlinePlus.Golimumab injection.
U.S. Food and Drug Administration.Information on tumor necrosis factor (TNF) blockers (marketed as Remicade, Enbrel, Humira, Cimzia, and Simponi).
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