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[Pharmacology](https://durgical.com/en/pharmacology/) · Class

# TNF inhibitors

Biologic medicines that block TNF-α, a key cytokine of inflammation. Used in rheumatoid arthritis, spondylitis, psoriasis and bowel disease.

Updated 2026-11-01

## What they are

Five biologics neutralise tumour necrosis factor alpha (TNF-α): the monoclonal antibodies infliximab, adalimumab and golimumab, the pegylated Fab fragment certolizumab pegol, and the receptor fusion protein etanercept. They control inflammation and slow joint damage when conventional DMARDs such as methotrexate are not enough.

## Mechanism of action

TNF-α is made by macrophages and T cells; it activates the endothelium, recruits neutrophils, drives the release of IL-1 and IL-6 and stimulates osteoclasts and synovial cells. Binding soluble and membrane TNF stops this cascade. The same cytokine keeps granulomas closed, which is why latent tuberculosis can reactivate.

Target: Tumour necrosis factor alpha (TNF-α)

## Key points

- Screen for latent tuberculosis and hepatitis B before the first dose; TB can reactivate as disseminated or extrapulmonary disease.
- No live vaccines during treatment; vaccines are updated before starting.
- Avoided or used with great caution in heart failure and demyelinating disease.
- Names: -mab = monoclonal antibody (infliximab chimeric, adalimumab and golimumab human); -cept = receptor fusion protein (etanercept).
- Etanercept is not approved for Crohn disease or ulcerative colitis; infliximab, adalimumab, certolizumab pegol and golimumab have bowel indications.

## Drugs in this class

- [**Adalimumab** A fully human antibody against TNF-α, injected under the skin, for rheumatoid arthritis, spondylitis, psoriasis and… Tumour necrosis factor alpha (TNF-α), soluble and membrane-bound](https://durgical.com/en/pharmacology/adalimumab/)
- [**Infliximab** A chimeric (part mouse) antibody against TNF-α given as an intravenous infusion, mainly for Crohn disease, ulcerative… Tumour necrosis factor alpha (TNF-α)](https://durgical.com/en/pharmacology/infliximab/)
- [**Etanercept** A decoy TNF receptor joined to an antibody tail; it soaks up TNF. Injected for rheumatoid, psoriatic and spinal… Tumour necrosis factor alpha (TNF-α)](https://durgical.com/en/pharmacology/etanercept/)
- [**Certolizumab pegol** An anti-TNF antibody fragment (Fab) attached to polyethylene glycol, injected under the skin for Crohn disease and… Tumour necrosis factor alpha (TNF-α)](https://durgical.com/en/pharmacology/certolizumab-pegol/)
- [**Golimumab** A human anti-TNF antibody given by injection under the skin or by infusion, for rheumatoid, psoriatic and spinal… Tumour necrosis factor alpha (TNF-α)](https://durgical.com/en/pharmacology/golimumab/)

## Test yourself

Think of the answer, then tap the question to see it.

## Which test must be done before starting any TNF inhibitor, and why?

A test for latent tuberculosis (skin test or interferon-gamma release assay): TNF keeps granulomas intact, so blocking it can reactivate TB.

## Which TNF inhibitor is a receptor fusion protein rather than an antibody?

Etanercept: the TNF receptor 2 ectodomain joined to the Fc part of human IgG1.

## In which two conditions are TNF inhibitors avoided or used with great caution?

Heart failure (it can worsen) and demyelinating disease such as multiple sclerosis.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - ADALIMUMAB- adalimumab-adaz injection, solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3468792f-63ef-4916-8ed1-8214f327d9dd) (DailyMed (U.S. National Library of Medicine), 2025); [DailyMed - INFLIXIMAB injection, powder, lyophilized, for solution](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b05c174f-832c-4321-b34f-2c4ad3742269) (DailyMed (U.S. National Library of Medicine), 2025); [Altered Immunocompetence | Vaccines & Immunizations | CDC](https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html) (Centers for Disease Control and Prevention (CDC), 2024); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 39 (McGraw Hill, 2023).

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