What are anti-TNF-α drugs?
- TNF-α or tumour necrosis factor alpha is a molecule produced by our immune system. It plays a key role in inflammation. In excessive quantities, TNF-α can cause chronic inflammation and tissue damage.
- Anti-TNF-α drugs block the action of this molecule, reducing inflammation and relieving symptoms.
- These drugs are part of the biotherapies and are therefore exceptional medicines.
Indication
- Several anti-TNF-α drugs are available in injectable form under the skin (subcutaneous) or through the veins (intravenous) via a syringe or pen.
- The first subcutaneous injections are carried out by a nurse and can then be performed by the patient themselves.
- Once collected from the pharmacy, it should be kept in your fridge at a temperature of between 2°C and 8°C.
Pre-therapy assessment
Before starting treatment, your specialist will carry out a check-up called ‘pre-biotherapy’ to :
- rule out any contraindications to treatment
- rule out any infection (tuberculosis, dental infection, etc.).
- update compulsory vaccinations.
Advice on administering
- Take the medicine out of the fridge 30 minutes before injection so that it is at room temperature.
- Do not reheat it, as this could inactivate the molecule!
- Place an ice pack in a cloth on the skin for 15 minutes to anaesthetise the skin.
- Wash your hands and disinfect your skin thoroughly before injecting.
- Vary the injection sites regularly: lower abdomen, thighs, outer and upper arm if other sites are not accessible.
- Do not purge the pre-filled syringe before administration.
Tolerance
Anti-TNF-α drugs are usually very well tolerated.
Like all biotherapies, they require monthly biological monitoring initially, then more frequently.
It is also advisable to use sun protection factor 50+, to monitor the skin for sun-induced skin lesions and to use a sunscreen.
monitor the skin for sun-induced skin lesions, and consult a dermatologist if any new lesions are suspected.
Practical questions
- Infection/fever: inform your doctor immediately so that anti-infection treatment can be started quickly and/or anti-TNF-α treatment can be temporarily stopped, depending on the severity of the infection.
- Surgery:
➢it is not necessary to interrupt treatment in the case of minor procedures such as scaling, tooth extraction or dental implant placement.
➢However, in the event of major surgery, a temporary interruption of treatment should be discussed with your specialist doctor.
Vaccination under Anti-TNF alpha
- The only vaccines contraindicated are live attenuated vaccines.
- If you need to be vaccinated because you are travelling, you should inform your specialist so that treatment can be temporarily suspended.
- Annual flu and pneumococcal vaccinations are strongly recommended.
Fertility, pregnancy & breastfeeding
- More and more reassuring data are available concerning fertility, pregnancy and breastfeeding with anti-TNF-α.
- The use of anti-TNF-α during pregnancy should be discussed on a case-by-case basis, particularly when there is a risk to the patient or baby in relation to the underlying disease.
- If it is necessary to continue anti-TNF-α treatment, Certolizumab-pegol or Etanercept will be preferred to other treatments on the basis of current data.