Anti-TNF is biological agent that targets an inflammation causing substance called TNF.
When TNF is present in excessive concentrations, is responsible for the destructive inflammatory process that occur in RA.
It acts by blocking the effect of TNF. Thus, reduce inflammation and stop disease progression.
It is reserved for moderate to severe RA that has not responded to one or more of the traditional disease modifying anti-rheumatic drugs (DMARDs) such as methotrexate.
It is also used in psoriatic arthritis and ankylosing spondylitis.
There are five anti-TNF drugs available including Infliximab, Adalimumab, Etanercept, Certolizumab and Golimumab.
It may be used monotherapy (Adalimumab, Etanercept and Certolizumab) or in combination with DMARDs (all anti-TNF).
Long term use of anti-TNF may increase the risk of lymphoma and other cancers. You may be more at risk if you are also taking immunosuppressant such as methotrexate and azathioprine.
Patient should be tested for tuberculosis before starting anti-TNF therapy.
Hepatitis B and C testing may be done. Hepatitis B and C infection may get worse during the anti-TNF therapy.
If you have heart problems, as anti-TNF could make your symptoms worse, therefore your heart will need to be monitored closely before and after the treatment.
Come back to the hospital for regular blood test as instructed by your doctor.
Because adverse effects can happen at any time during the course of treatment and some side effects may not cause symptoms, it is really important that you have your regular blood test. This can monitor the side-effects of anti-TNF.
Move the injection site where you give the shot each time.
It may be given by injection under the skin, e.g.: Adalimumab, Etanercept, Certolizumab and Golimumab (administer at home) or by infusion, e.g.: Infliximab (administer in hospital up to 2-4 hours)
Injection under the skin can be injected into the abdomen or thigh.
Starting, maintenance dose and time to effect :
Initial: 3-5 mg/kg (Week 0, 2, 6)
Maintain: 5-10mg/kg every 4-8 w
Initial: 400mg (Week 0, 2, 4)
Maintain: 200mg every other week
Take the missed dose as soon as you remember.
Then take your next injection as you would have on your originally scheduled day.
If it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule.
Do not take a double dose to make up a missed dose.
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