The anti-TNFs are the most widely used biologics in the treatment of Inflammatory Arthritides and Inflammatory Bowel Diseases.
The most feared complication is infection, especially Tuberculosis and invasive fungal infections. However, with screening and close surveillance during treatment, such risks have become very manageable.
Postoperative infection risk is definitely increased, and the anti-TNF should be omitted by a 2-dose duration prior to surgery (if feasible). Resumption is after adequate wound closure.
If this sounds rather arbitrary, that’s because it is. No study has demonstrated the “safe period” for stopping and restarting anti-TNF in order to “normalise” perioperative infection risk. The latter also depends on the type and site of surgery, and whether prostheses are inserted.
The other major concern in anti-TNF use is malignancy. After all, TNF does stand for Tumour Necrosis Factor: it is part of the body’s natural defence against the development of cancers.
The longterm registries of anti-TNF usage in SpA surveyed in this study did not show any such signal. The higher risk of lymphoma in anti-TNF users in RA has been explained as bad RA itself predisposing to the development of lymphoma.
RA patients seem to be also at higher risk of developing skin cancer (non-melanoma) spontaneously. Anti-TNF use increases the risk (slightly) further for squamous cell carcinoma.
Anti-TNF is contraindicated in patients with a history of melanoma, which is a TNF-sensitive tumour.
This is a handy infosheet for patients using biologics (not only anti-TNF).