USMLE

TNF Inhibitors

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Musculoskeletal Drugs
  1. Azathioprine
  2. Corticosteroids
  3. Sulfasalazine
  4. TNF Inhibitors
  5. Immunosuppressants (Cyclosporine, Mycophenolate, Tacrolimus)
  6. Acetaminophen
  7. NSAIDs
  8. Colchicine
  9. Allopurinol
  10. Rasburicase
  11. Dantrolene
  12. Muscle Relaxants
  13. Bisphosphonates: Alendronate, Risedronate

Summary

Tumor Necrosis Factor Inhibitors, or TNF inhibitors for short, include the drugs adalimumab, infliximab, and etanercept. These drugs have potent anti-inflammatory properties that make them useful in treating inflammatory autoimmune conditions like rheumatoid arthritis and ulcerative colitis. TNF inhibitors cause immunosuppression, putting the patient at an increased risk for infection. In particular, patients taking these drugs are at a high risk of tuberculosis infections, so all patients should expect to receive a baseline TB test, as well as subsequent yearly screening tests.

Key Points

  • Tumor Necrosis Factor (TNF) Inhibitors
    • Key Drugs
      • Infliximab
      • Adalimumab
      • Etanercept
      • Golimumab
      • Certolizumab
    • Mechanism
      • Immunomodulator
        • Reduces TNF signaling at receptors to reduce the inflammatory response
      • Monoclonal antibody
    • Clinical Use
      • Anti-inflammatory
        • Rheumatoid Arthritis
        • Ulcerative Colitis
        • Psoriasis
        • Crohn’s disease
        • Ankylosing spondylitis
    • Side Effects and Adverse Reactions
      • Immunosuppression / Increased risk of infection
        • Contraindicated in patients with active infection
        • Patients should receive a baseline TB test and yearly tests during treatment, as TNF inhibitors can cause activation of latent TB
        • Monitor CBC and notify provider of elevated white blood cell count, as this can indicate an infection