TNF inhibitors: mechanism, screening and adverse effects
How the five TNF inhibitors differ in structure and why that matters for IBD, granulomatous disease and pregnancy, why TNF blockade reactivates TB and hepatitis B, how to read drug levels and anti-drug antibodies after loss of response, and the class contraindications.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- TNF is made by macrophages and T cells. It exists as a transmembrane form and a soluble trimer that signals through TNFR1 and TNFR2. It drives synovitis, cartilage and bone erosion, endothelial activation and the acute phase response, and it holds granulomas together.
- Five agents are used in Australia: infliximab, adalimumab, golimumab, certolizumab pegol (all monoclonal antibodies or fragments) and etanercept (receptor fusion protein). Biosimilars of infliximab, adalimumab and etanercept are on the PBS.
- Indications: RA, psoriatic arthritis, axial spondyloarthritis, Crohn disease and ulcerative colitis (infliximab, adalimumab), ulcerative colitis (golimumab), psoriasis, hidradenitis suppurativa and non-infectious uveitis (adalimumab).
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Sources
- Australian Rheumatology Association: screening for latent tuberculosis and hepatitis B before biological DMARDs; patient medicine informationAU/NZAustralian Rheumatology Association, online, accessed November 2026
- Pharmaceutical Benefits Scheme: biological DMARDs for severe active rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitisAU/NZAustralian Government Department of Health, Disability and Ageing, Schedule accessed November 2026
- EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 updateAnnals of the Rheumatic Diseases (Smolen et al., 2023;82:3-18), 2022 update
- The Australian Immunisation Handbook: vaccination for people who are immunocompromisedAU/NZAustralian Technical Advisory Group on Immunisation, online, accessed November 2026
- Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agentNew England Journal of Medicine (Keane et al., 2001;345:1098-104), 2001
- Proactive and reactive therapeutic drug monitoring of biologics in IBD: American Gastroenterological Association clinical practice guidelineGastroenterology (Feuerstein et al., 2017;153:827-34), 2017
- The Australian Immunisation Handbook: infants exposed to immunosuppressive therapy in utero or through breastmilkAU/NZAustralian Government Department of Health, Disability and Ageing, current at November 2026
- Last updated
- 14 November 2026
What changed
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