When Should You Change Your TNF Blocker?

If you're taking a tumor necrosis factor (TNF) blocker for rheumatoid arthritis (RA) or another type of inflammatory arthritis that such a drug is indicated for, you should know that these medications all work a little differently. Try not to be discouraged if the first (or second) TNF blocker you take doesn't do enough to alleviate your symptoms and improve your functionality. This is not uncommon. Luckily, there is an array of other TNF blockers that your doctor can recommend.

Reasons to Change Your TNF Blocker

People may need to switch to a different TNF blocker for one or more reasons.

Good reasons for considering a change include:

  • Unsatisfactory response to treatment
  • Diminished effectiveness over time
  • Undesirable side effects of treatment

Clear expectations for treatment are important to making the decision to change medications. Discuss your treatment goals with your doctor and ask what the drug you're on can and can't do, and in what anticipated timeframe. Is the medication expected to put your RA into remission? How long will this take?

This can help you better understand if it may be time to switch or if you just need to wait longer for the drug's full effectiveness to kick in.

Once you have a sense that your treatment isn't having the effect you anticipated, or if it is no longer helping you meet your goals, bring it up with your doctor. You may need an increased dosage, a second medication, or a different medication.

If you experience side effects that are severe, interfere with your daily life, or don't diminish over time, let your doctor know this too. You may benefit from switching drugs or taking lower doses of your current drug and adding another.

Can Switching Help?

Is it possible for a patient to have a better response to a different TNF blocker or are they all the same? Can a patient go back on a TNF blocker after having stopped it We asked Scott J. Zashin, M.D.—clinical professor of internal medicine (rheumatology division) at the University of Texas Southwestern Medical School at Dallas, and Verywell Health medical review board member—to weigh in.

"At least 70% of patients with rheumatoid arthritis who start one of the TNF blockers will get significant improvement in their condition," said Dr. Zashin. "Even more patients will get benefit when methotrexate (Rheumatrex, Trexall) or another DMARD (disease-modifying anti-rheumatic drug) is combined with a TNF blocker."

He went on to add support for having faith in the trial-and-error process. "If a patient does not respond to the initial TNF blocker after three months, switching to another will increase their chance of benefit. In fact, even if a patient has not responded to two of the TNF blocker drugs, it may still be useful to try a third," he said.

As a matter of fact, study results published in 2010 concluded that patients with spondyloarthritis who failed to respond to Enbrel (etanercept) or Remicade (nfliximab) as the first agent did respond to Humira (adalimumab) after switching, regardless of why they switched.

Furthermore, another study, published in 2013, showed that participants with RA were able to stick with Enbrel and Humira longer than they were Remicade.

According to Dr. Zashin, while patients who have previously gone off of Enbrel or Humira can go back on those drugs without concern, those who have been off Remicade for a prolonged period of time face the risk of potentially dangerous infusion reactions.

These factors may guide your doctor's decision about what medication to start you on, as well as which one(s) to switch you too.

Other Drugs to Consider

While Enbrel, Remicade, and Humira have been around the longest, newer TNF blockers are now available and may be considered as part of your treatment:

If you've tried several TNF blockers without adequate success, your doctor may consider other biologic drugs, such as:

Janus kinase (JAK) inhibitors are a newer class of drugs used for RA. These include:

  • Jakaft (ruxolitinib)
  • Olumiant (baricitinib)
  • Rinvoq (upadacitinib)
  • Xeljanz (tofacitinib)

A Word From Verywell

The key to finding the RA medications that work best for you is open communication with your doctor. Keep appointments and get in touch with them if you have any questions or concerns about symptoms, prescriptions, or other treatments.

It may be frustrating to try several drugs before finding one or a combination that works well. But remember that this is a means to an end that may bring remission and a better quality of life.

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Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Spadaro A, Punzi L, Marchesoni A, et al. Switching from infliximab or etanercept to adalimumab in resistant or intolerant patients with spondyloarthritis: a 4-year study. Rheumatology (Oxford). 2010;49(6):1107-11. doi:10.1093/rheumatology/keq008

  2. Scirè CA, Caporali R, Sarzi-puttini P, et al. Drug survival of the first course of anti-TNF agents in patients with rheumatoid arthritis and seronegative spondyloarthritis: analysis from the MonitorNet database. Clin Exp Rheumatol. 2013;31(6):857-63.

Additional Reading
  • Interview with Scott J. Zashin, M.D., FACP, FACR.