TNF = inflammatory cytokine

• Adalimumab (humira)

• Infliximab (Remicade)

• monoclonal antibodies active against TNF

• neutralise inflammatory effect of TNF by binding

• often given SC

Contraindications

• severe active infections

• untreated active/latenet Tb

• Moderate to severe congestive heart failure

• MS or optic neuritis

Adverse effects

• injectin side reactions

  • lessened with pre-treatment antihistamines

  • ice

  • or topical corticosteroid

• infusion reactions

• reactivation of Tb

  • likely to occur in first 12mo

• malignancy, heart failure

need to treat infections early even if minor

monitoring

• monthly for 6/12 then every 3-6mo

• CBC

  • stop if WBC \<3.4, n \<2, pl \<150

• LFT

  • advice if ALT > twice upper limit of normal