Table 2– Tumour necrosis factor antagonists: licensed indications, conditions for prescription and dosing
Licensed indicationsInfliximabEtanerceptAdalimumabGolimumabCertolizumab
Rheumatoid arthritis+§+§,ƒ+§,ƒ+§+§,ƒ
 Active disease and inadequate response to DMARD including MTX#+§+§,ƒ+§,ƒ+§+§,ƒ
 Patients with severe and progressive/erosive disease without prior DMARD therapy#Dosing:3 mg·kg−1 i.v. week 0, 2, 6 then 8-weeklyInadequate response: increase to 7.5 mg·kg−1 8-weekly or 3 mg·kg−1 4-weeklyDosing:25 mg sc twice a week or 50 mg sc once a weekDosing40 mg sc 2-weeklyDosing50 mg sc 4-weeklyDosing400 mg sc week 0 and 2, then once a month
 Patients with moderately to severely active disease
Ankylosing spondylitis++++
 Inadequate response to conventional therapy (i.e. NSAID)#Dosing:3 mg·kg−1 i.v. week 0, 2, 6 then 6–8-weeklyDosing:25 mg sc twice a week or 50 mg sc once a weekDosing40 mg sc 2-weeklyDosing50 mg sc 4-weekly
 Active disease
Psoriatic arthritis+§,ƒ+++§,ƒ
 Active disease and inadequate response to DMARD including MTX#Dosing:3 mg·kg−1 i.v. week 0, 2, 6 then 8-weeklyDosing:25 mg sc twice a week or 50 mg sc once a weekDosing40 mg sc 2-weeklyDosing50 mg sc 4-weekly
 Active arthritis
Juvenile idiopathic arthritis++
 Age >4 and <18 yrs and active disease and inadequate response to or intolerance of DMARD including MTX#Dosing:0.4 mg·kg−1 sc twice a weekDosing40 mg sc 2-weekly
 Patients with moderately to severely active disease
Crohn's diseaseDosing5 mg·kg−1 i.v. week 0, 2, 6 then 8-weeklyIf ineffective increase to 10 mg·kg−1 every 8 weeksNot usedDosing160 mg sc, followed by 80 mg sc then 40 mg every second weekNot approvedDosing400 mg sc at weeks 0, 2 and 4 followed by 400 mg every 4 weeks (not yet approved in Europe)
Ulcerative colitisDosing5 mg·kg−1 i.v. week 0, 2, 6 then 8-weeklyIf ineffective increase to 10 mg·kg−1 every 8 weeksNot usedNot yet approvedNot yet approvedNot yet approved
PsoriasisDosing5 mg·kg−1 i.v. at weeks 0, 2, 6 and then every 8 weeksDosing25 mg sc twice weekly or 50 mg weekly up to 24 weeks or 50 mg twice weekly up to 12 weeks and weekly thereafterDosing80 mg sc week 0, 40 mg week 1 and alternate weeks thereafterNo current dataNo current data
 Very severe plaque psoriasis PASI >20, DLQI >18 and failure or contraindication to 2nd line drugs (MTX, cyclosporine, PUVA)
 Severe plaque psoriasis PASI >10, DLQI >10 and failure or contraindication to 2nd line drugs (MTX, cyclosporine, PUVA)
  • DMARD: disease-modifying anti-rheumatic drug; MTX: methotrexate; NSAID: nonsteroidal anti-rheumatic drug; PASI: Psoriasis Area Severity Index; DLQI: Dermatology Life Quality Index; PUVA: psoralen ultraviolet A-range; sc: subcutaneously. #: plus MTX; : without MTX if contraindicated or not tolerated; §: European Medicines Agency approved indication; ƒ: Federal Drug Administration approved indication.