I. Pharmacology

  1. Genetically engineered monoclonal antibodies against tumor necrosis factor-alpha; binds to it and prevents its binding to cellular receptors

II. Adverse effects

  1. Headache
  2. Nausea
  3. Injection reactions (fever, urticaria, dyspnea, hypotension)
  4. A lupus-like syndrome
  5. Increased incidence of lymphoma
  6. Opportunistic bacterial infections, including reactivation of Tuberculosis so consider screening for latent tuberculosis before treatment.
  7. Exacerbations of demyelinating diseases have been associated with use of these meds
  8. Infliximab and etanercept have been associated with increased risk of lymphoma, though causality is unclear and highest risk may be with use of concomittant use of immunosuppressive agents (Arth. Rheum. 62:2517, 2010-JW)

III. Clinical uses

  1. Crohn's Disease and Ulcerative Colitis
  2. Rheumatoid Arthritis

IV. Specific drugs

  1. Infliximab (Remicade) 40mg SQ Q2wks
    1. A chimeric (human-mouse) monoclonal antibody
  2. Etanercept (Enbrel) 25mg SQ 2x/wk
  3. Adalimumab (Humira) 40mg SQ Q2wks