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TNF (tumor necrosis factor) inhibitors are medications that suppress inflammation within your immune system. They treat rheumatic diseases like inflammatory arthritis and inflammatory bowel disease.
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TNF inhibitors (anti-TNF) are medications that treat autoinflammatory and autoimmune diseases. These drugs inhibit — block the action of — a type of protein in your body called tumor necrosis factor (TNF) alpha. TNF alphas play an important role in generating chronic inflammation in certain immune system disorders. TNF alpha inhibitors work to stop the process that produces the inflammation.
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The U.S. Food and Drug Administration (FDA) has approved the use of TNF alpha inhibitors to treat:
Healthcare providers may also prescribe anti-TNF treatment to treat other conditions when they believe it might be helpful. This is called off-label drug use. Some of the off-label uses of TNF blockers include:
TNF inhibitors currently approved by the U.S. Food and Drug Administration (FDA) include:
The FDA has also recently approved several biosimilar drugs for infliximab (Remicade) and adalimumab (Humira). These are similar alternatives that mimic the original drug (like generics for biologic drugs).
Biosimilars for infliximab (Remicade) include:
Biosimilars for adalimumab (Humira®) include:
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Biosimilars for other TNF inhibitors are also in progress.
TNF inhibitors are biologic DMARDs (disease-modifying anti-rheumatic drugs). DMARDs treat rheumatic diseases by reducing chronic inflammation in your tissues. Biologics are medications derived from biological organisms. Biologic DMARDs are a relatively new class of drugs. They’re more effective than traditional DMARDs, but also more difficult — and therefore more expensive — to produce.
Anti-TNF biosimilars are also biologics. They’re just slightly different formulas. Biologics, by nature, can’t be reproduced exactly. But biosimilars are produced in a similar way, and they’re not significantly different. They’re equally effective and often less expensive to produce. This may, in theory, translate into consumer savings. However, many factors affect drug pricing and what consumers pay for drugs.
TNF is a type of cytokine, a protein that acts as a chemical messenger in your immune system. When TNF binds to receptors on your cells, it sends a signal to activate inflammatory processes. There are two types of TNF: alpha and beta. Both types of TNF are involved in inflammation, but anti-TNF therapy targets TNF alpha, specifically. It blocks TNF alpha from binding to its receptors.
Tumor necrosis factor (TNF) inhibitors are injection medications. They need to go straight to your bloodstream to work. Many people take TNF inhibitors by self-injection. A small needle delivers a small dose just under your skin. You may take it weekly, biweekly or monthly. Or you may take your TNF blocker by IV (through a vein) at your healthcare provider’s office. You’ll sit for an infusion every month or two.
TNF inhibitors have revolutionized the treatment of rheumatic diseases by effectively stopping inflammation before it starts. They’re especially helpful when these diseases cause different kinds of inflammatory symptoms in different parts of your body. They’re safe for long-term use, even when pregnant or breastfeeding. There are also some side benefits to using them long-term, including:
TNF alpha inhibitors don’t always work for everyone. Some people’s immune systems reject the treatment, creating antibodies that target and remove it. This can also happen after many years of use, making the treatment less effective or ineffective over time. When they do work, TNF alpha inhibitors suppress your immune system. This weakens your defenses against infectious diseases.
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Other potential side effects include:
Most people say their symptoms start to improve after the first few doses. Some people need a few months of treatment before they can tell their TNF blocker is working. And for a few people, it might not ever work. If this happens to you, your healthcare provider might suggest a different TNF inhibitor. Or they might suggest a different type of biologic DMARD — one that targets a different type of cytokine.
Most of the conditions TNF inhibitors treat are lifelong. So, you’ll need some form of medical care for life, whether that means medication or simply monitoring. In the past, stopping treatment wouldn’t have been a realistic goal. But if your symptoms disappear completely, after several years, you may be able to start tapering off your TNF inhibitor. Your provider will monitor what happens when you do.
TNF alpha inhibitors have made a real difference for people living with rheumatic diseases. Today, these medications are often the first line of treatment your rheumatologist will suggest. For some people, they work so well that symptoms seem to disappear. But no treatment is a silver bullet for everyone. If they aren’t the answer for you, your provider will offer another option.
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Last reviewed on 07/02/2025.
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