Biologics (TNF inhibitors)
Biological therapies (biologics) include tumour necrosis factor (TNF) inhibitors. They are used to treat some types of autoimmune conditions when standard treatments have been unsuccessful.
When you might use TNF inhibitors
If you have an autoimmune condition your body's defence system (immune system) attacks your healthy tissues. Autoimmune conditions include:
- rheumatoid arthritis and psoriatic arthritis (both also known as inflammatory arthritis)
- inflammatory bowel conditions such as Crohn's disease
- skin conditions such as chronic plaque psoriasis.
How TNF inhibitors work
TNF inhibitors block a natural inflammatory substance in your body called tumour necrosis factor alpha. The medication helps to decrease swelling and weakens your immune system, also slowing or stopping the damage caused by the condition. TNF inhibitors include as adalimumab, etanercept and infliximab.
TNF inhibitors are given by injection either into your skin or into a vein by an intravenous drip.
Before starting a TNF inhibitor
TNF inhibitors can have serious side effects including raising your risk of infection. Before prescribing a TNF inhibitor, your healthcare provider may carry out some tests for infections, including:
- tuberculosis (TB)
- all types of hepatitis
- chickenpox.
They will also review your immunisation records to make sure you have received all of the vaccines recommended on the National Immunisation Schedule. You may need to catch up on some if you have missed any.
National Immunisation Schedule
Catching up on missed immunisations
You must avoid having live vaccines if you are using a TNF inhibitor. These vaccines are:
- varicella (chickenpox) vaccine
- tuberculosis (BCG) vaccine
- measles, mumps and rubella (MMR) vaccine.
The following vaccines are safe to take:
- hepatitis A vaccine
- hepatitis B vaccine
- influenza (flu) vaccine
- pneumococcal vaccine
- HPV (human papillomavirus) vaccine.
While you are receiving a TNF inhibitor, your healthcare provider will also order blood tests regularly to monitor its safety and how well it is working.
Side effects and increased risk of infection
TNF inhibitors can cause side effects, although not everyone gets them. They include bruising, redness and tenderness at the injection site. If this happens:
- change the site for each injection into the skin
- tell your healthcare provider or phone Healthline on 0800 611 116 for advice.
Because TNF inhibitors weaken your immune system they can lead to an increased risk of infections. These may be mild such as a cold, or they may be more severe such as an infection of your blood (septicaemia).
Contact your healthcare provider immediately or phone Healthline on 0800 611 116 for advice if you develop:
- signs of infection such as a high temperature, an ongoing cough, weight loss, sore throat or feeling weak, tired and unwell
- signs of an allergic reaction such as muscle or joint pain, fever, rash, intense itching, swelling of your face or hands, sore throat, headache or difficulty swallowing.