What is Certolizumab?
Certolizumab is a targeted disease modifying anti-rheumatic drug (DMARD) that is used to reduce inflammation produced by the body. In certain diseases the immune system is over active, this can target healthy tissues such as joints. Certolizumab works on the inflammatory pathway to inhibit proteins called tumour necrosis factors or TNF, reducing the symptoms you get from arthritis such as pain and joint swelling and reduces the chance of further damage to the joints.
Certolizumab is known as an anti-TNF biological from its effects, there are other medications in this group such as adalimumab or etanercept.
What is Certolizumab used for?
Certolizumab is used for the treatments of inflammatory diseases such as:
How is it taken?
Certolizumab is taken as an injection into the layer of fat between the skin and muscle. This is called a subcutaneous injection and is usually given into the thigh or abdomen.
It is initially given as a loading dose of 400mg (2 injections of 200mg) on a fortnightly basis for the first 3 doses. It is then dropped down to 200mg (1 injection of 200mg) every fortnight from dose 4.
The injection device is available as a pen or prefilled syringe. It should be stored in the fridge at home.
Certolizumab can be given alongside other DMARDs such as methotrexate, or taken on its own.
The injections can take up to 12 weeks to have an effect. When you first start taking it you will need your bloods checked after 3 months of taking it, you will then require bloods to be taken once a year. If you are on other medication, you must still attend for blood monitoring for them.
If you symptoms are well controlled, your doses can be gradually reduced to every 3 or 4 weeks.
There are a few possible side effects that can occur in a small number of people that take certolizumab, these include:
- Feeling sick, vomiting and headaches
- These usually settle after taking the injections for a few weeks.
- Increased risk of infections
- As certolizumab dampens the immune system, you can be more prone to infection. You should be seen by your GP if you feel unwell in case you need antibiotics. You must temporarily stop your injections whilst you are unwell and receiving treatment, they can be started up again when you feel well.
- You should try to avoid contact with others that have chicken pox or shingles.
- Injection site reactions
- Irritation, rashes and blistering can occur.
- Mild steroid creams and antihistamines can be used to settle things down. If these don’t work, then you should see your GP.
- Small increased risk of non-malignant skin cancer
- Anti-TNF treatments have been associated with a small increased risk, you should try to reduce your risk by being safe in the sun and assessing your moles regularly.
- Drug induced lupus
- Rarely certolizumab can cause a rash, joint pains and fevers. If this occurs it usually stops after stopping the injections.
Cautions of use
Interactions with other medications
- Your doctor will check if there are any medications that could interact. You can carry on taking your usual painkillers including NSAIDs.
Contraindications of other conditions
- Before starting any biological therapy, your bloods will be checked for infections that can become active again when the immune system is suppressed, this includes hepatitis B, C and HIV. A blood and chest X-ray is taken to exclude previous TB exposure. If you are found to have had previous TB exposure you may need to start preventative antibiotics for a short period before the certolizumab is commenced.
- Certolizumab is not safe to be used if you are being investigated for or have been diagnosed with cancer.
- Certolizumab is not used if you or a close family member have been diagnosed with multiple sclerosis (MS).
- If you have severe lung and heart conditions, anti-TNF treatments may not be suitable.
- Certolizumab should be withheld for 3 weeks prior to surgery.
During pregnancy and breastfeeding
- Certolizumab is safe for use during the whole of pregnancy.
- It is safe to take during breastfeeding.
- Your baby may need to have an altered vaccination schedule; this should be discussed with your doctors.
- There is some evidence to suggest it is safe to be used by the male partner during conception and during their partner’s pregnancy.
- Alcohol and certolizumab do not interact, however it is recommended to take alcohol within moderation, following the guidelines of less than 14 units weekly.
- Flu and the pneumonia vaccine are safe and recommended whilst taking certolizumab.
- Live vaccines including the shingles vaccine should not be given due to the dampening down of the immune system.
Versus Arthritis: http://www.versusarthritis.org