Which medications in the drug class TNF Inhibitors are used in the treatment of Inflammatory Bowel Disease?

Updated: Apr 10, 2020
  • Author: William A Rowe, MD; Chief Editor: BS Anand, MD  more...
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TNF Inhibitors

Monoclonal antibodies targeted against tumor necrosis factor alpha (TNFα) interrupt endogenous TNF. Increased TNFα levels have been observed in Crohn disease and ulcerative colitis and are thought to be part of the pathogenesis of IBD. TNFα induces proinflammatory cytokines (eg, interleukins), enhances leukocyte migration, activates neutrophils and eosinophils, and induces enzymatic degradation.

This class includes adalimumab, certolizumab, golimumab, and infliximab. Infliximab and adalimumab are FDA approved for both Crohn disease and ulcerative colitis, whereas certolizumab is FDA approved only for Crohn disease and golimumab only for ulcerative colitis.

Infliximab was the first of this class for use in inflammatory bowel disease. [70] Infliximab is more effective against Crohn disease than ulcerative colitis. This drug promotes mucosal healing; heals perianal and enterocutaneous fistulas; and has been shown to reduce signs and symptoms, achieve clinical remission and mucosal healing, and eliminate corticosteroid use. [133] Infliximab is indicated for patients who have experienced inadequate response to conventional therapy. [109]

Infliximab (Remicade)

Infliximab neutralizes cytokine TNF-alpha and inhibits its binding to the TNF-alpha receptor. It is mixed in 250 mL of normal saline and infused IV over 2 hours. It is indicated for both ulcerative colitis and Crohn disease.

Adalimumab (Humira)

Adalimumab is a TNF blocking agent that has been FDA approved for both Crohn disease and ulcerative colitis. It is administered by subcutaneous injection.

Adalimumab is recombinant human immunoglobulin (Ig) G1 monoclonal antibody specific for human TNF. It binds specifically to TNF-alpha and blocks the interaction with p55 and p75 cell-surface TNF receptors.

Certolizumab pegol (Cimzia)

Certolizumab is a TNF blocking agent that has been FDA approved for the treatment of Crohn disease but not for ulcerative colitis. It is administered by subcutaneous injection.

Certolizumab pegol is a pegylated antitumor necrosis factor (TNF)–alpha blocker, which results in disruption of the inflammatory process. It is indicated for moderate to severe Crohn disease in individuals whose condition has not responded to conventional therapies.

Golimumab (Simponi, Simponi Aria)

Human anti-TNF-alpha monoclonal antibody. Indicated for ulcerative colitis but not Crohn disease. It is administered by SC injection.

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