Cimzia (certolizumab pegol) is a biologic medicine that targets a protein called TNF-alpha (tumour necrosis factor alpha), which plays a key role in driving inflammation. By blocking TNF-alpha, Cimzia helps reduce the inflammation responsible for symptoms in several chronic conditions.

Cimzia is used to treat:

• Rheumatoid arthritis (RA): Moderate to severe RA, usually alongside methotrexate
• Psoriatic arthritis: Joint disease associated with psoriasis
• Axial spondyloarthritis: Including ankylosing spondylitis and non-radiographic axial spondyloarthritis, which cause back pain and stiffness
• Crohn's disease: Moderate to severe active disease in adults
• Plaque psoriasis: Moderate to severe psoriasis affecting the skin

How it works:

TNF-alpha is a chemical messenger that the immune system uses to trigger inflammation. In conditions like RA and Crohn's disease, TNF-alpha is overproduced, causing excessive and damaging inflammation. Cimzia binds to and neutralises TNF-alpha, reducing inflammation and its effects on joints, skin, and the gut.

Your dose:

Your doctor will prescribe the dose appropriate for your condition. The usual approach is an initial loading dose given over the first few weeks, followed by a lower maintenance dose. Always follow your doctor's schedule.

Before you start:

• You will be screened for tuberculosis (TB) and hepatitis B before starting Cimzia
• Tell your doctor about all medicines, vitamins, and supplements you take
• Let your doctor know about any history of infections, heart failure, nerve conditions, or cancer
• Tell your doctor if you are pregnant or planning to become pregnant. Cimzia has a unique profile among biologics: it transfers very minimally across the placenta, which may make it a preferred option in some pregnancies. Discuss this with your doctor

How it's given:

• Cimzia is injected under the skin (subcutaneously), usually into the thigh or abdomen
• Your nurse will train you or your carer to give the injection at home
• Allow the syringe or autoinjector to reach room temperature for 30 minutes before injecting
• Rotate injection sites to minimise skin reactions

• Take the missed injection as soon as you remember
• Then resume your regular schedule from that point
• If you are unsure, contact your doctor or rheumatology nurse for guidance

If you think you have injected more than prescribed, call your doctor or go to your nearest emergency department. There is no specific antidote, but medical staff can monitor and manage any symptoms.

• Store in the fridge at 2°C to 8°C
• Do not freeze
• Keep in the original packaging to protect from light
• If needed for travel, Cimzia can be stored at room temperature (up to 25°C) for up to 24 hours. Do not return it to the fridge afterwards
• Keep out of reach of children and pets

Like all biologic medicines, Cimzia can cause side effects. The most important ones to know about are:

• Infections: Blocking TNF-alpha reduces your immune defences. Watch for fever, chills, cough, or feeling very unwell and seek prompt medical attention
• Injection site reactions: Redness, pain, or swelling at the injection site. These usually resolve quickly
• Reactivation of TB or hepatitis B: Which is why screening is done before starting treatment
• Allergic reactions: Rare but possible. Seek immediate help if you develop difficulty breathing, swelling of the face, or a severe rash
• Worsening heart failure: Tell your doctor if you experience increasing breathlessness or swelling of the legs
• Neurological problems: In rare cases, biologic TNF inhibitors have been associated with nerve conditions. Tell your doctor if you notice unusual numbness, tingling, or vision problems

Contact your doctor or pharmacist if any side effect concerns you.

Tell your doctor and pharmacist everything you are taking before starting Cimzia.

Key interactions include:

• Other biologics: Combining Cimzia with other biologics such as abatacept or anakinra significantly increases infection risk and is generally avoided
• Live vaccines: Avoid live vaccines during treatment. Discuss any upcoming vaccinations with your doctor
• Methotrexate: Commonly used alongside Cimzia for RA. Both can affect the immune system, so close monitoring is needed

Never start, stop, or change any medicine without speaking to your doctor first.

Is Cimzia safe during pregnancy?

Cimzia has a unique characteristic among anti-TNF biologics: its structure means it crosses the placenta at very low levels compared to other medicines in this class. For some women, this may make it a preferred biologic option during pregnancy. However, this decision must always be made in close consultation with your rheumatologist and obstetrician.

How long before Cimzia starts working?

Some people notice an improvement within a few weeks of starting Cimzia, particularly in Crohn's disease. For joint conditions, it may take several weeks to a few months to feel the full benefit. Your doctor will assess your response at regular intervals.

Do I need to avoid people who are sick?

While on Cimzia, your immune system is less able to fight infections. It is sensible to avoid close contact with people who have active infections where possible, wash your hands regularly, and seek medical advice promptly if you develop any signs of infection.

Ace provides accurate and independent information medically reviewed on prescription medications. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.