25th February 2025

Specific biologics and side effects

Target	Action	Drug	Condition	Route	Other side effects
Anti-TNF	Blocks TNF	Etanercept Infliximab Adalimumab Certolizumab Golimumab	RA, AS, PsA	Infliximab IV Others SC	Injection site reaction, hypersensitivity, heart failure, demyelination, lupus-like syndrome, reactivation of TB**
Anti CD20	Depletes B cells	Rituximab	RA, GPA, MPA		Anaphylaxis, skin reaction
Anti BLyS/BAFF	Depletes B cells	Belimumab	SLE	IV	Depression, hypersensitivity
IL-1 receptor antagonist	Blocks interleukins	Anakinra	RA, Still’s disease	SC (daily)	Injection site reactions
IL-6 receptor antagonist (JAK inhibitor)	Blocks interleukins	Tocilizumab	RA, GCA	IV or SC	Dyslipidaemia, hepatitis, skin reaction, hypersensitivity
IL-12/23 antagonist	Reduces Th17 cell activation	Ustekinumab	PsA	SC	Skin reaction, facial palsy
IL-17A antagonist	Reduces Th17 cell activation	Secukinumab	AS, PsA	SC	IBD exacerbation
CTLA4-Ig	Disrupts T-cell activation	Abatacept	RA, PsA	IV or SC	Hypersensitivity

Table 3 Examples of different sub-classes of biologic, their uses, route of administration and side effects
*TNF inhibitors should not be prescribed in those with multiple sclerosis or severe heart failure (NYHA grade 3-4)
**Mainly with infliximab and adalimumab

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