Cimzia injection contains the active ingredient certolizumab pegol, which is a type of medicine called a tumour necrosis factor alpha (TNF alpha) blocker. It works by suppressing the process of inflammation.
\What is it used for?
- Moderate to severe rheumatoid arthritis.
- Certolizumab pegol is used in combination with methotrexate, when other DMARDs, for example sulfasalazine, methotrexate have not been effective. It can also be used for people with severe active progressive rheumatoid arthritis who have not previously been treated with methotrexate. Certolizumab pegol can also be used on its own for people who can’t take methotrexate, or when continued treatment with methotrexate is inappropriate.
How does it work?
- Cimzia injection contains the active ingredient certolizumab pegol, which is a type of medicine called a tumour necrosis factor alpha (TNF alpha) blocker. It works by suppressing the process of inflammation.
- TNF alpha is a protein produced by the body that is involved in causing inflammation.
It controls the activity of other inflammatory chemicals.
TNF alpha is found in increased levels in various inflammatory conditions. It is found in the inflamed joints of people with rheumatoid arthritis and in the joints of people who have a type of arthritis affecting the spine, called ankylosing spondylitis. It is also found in increased levels in skin affected by psoriasis, as well as in the joints of people who have a type of of arthritis called psoriatic arthritis, which can occur in people with psoriasis.
Inflammation occurs when TNF alpha acts on TNF receptors that are found on the surface of cells. Certolizumab pegol works by stopping TNF alpha from acting on these receptors. This prevents the inflammatory responses TNF alpha causes.
In arthritic conditions, treatment with certolizumab pegol reduces the movement of inflammatory cells into inflamed areas of the joints. This reduces the signs and symptoms of the arthritis, improves physical function of the joints and reduces the rate of joint damage. When treating arthritis, certolizumab pegol is referred to as a disease-modifying antirheumatic drug (DMARD).
Certolizumab pegol is only prescribed by specialists experienced with treating rheumatoid arthritis. It is administered as an injection under the skin (subcutaneously) once every other week.
Improvements in the symptoms of rheumatoid arthritis should be seen within 12 weeks of starting treatment.
Use with caution in
- Elderly people.
- Decreased kidney function.
- Decreased liver function.
- People with a history of hepatitis B.
- Dormant tuberculosis infection.
- People with a history of recurrent infections.
- People who are or who have recently been receiving treatment that suppresses the activity of the immune system, eg long-term oral corticosteroids, chemotherapy, radiotherapy, medicines to prevent transplant rejection.
- Mild heart failure.
- Demyelinating disorders such as multiple sclerosis.
- People who are due to have a joint surgically repaired.
- History of or current cancer.
- Heavy smokers.
- Chronic obstructive pulmonary disease (COPD).
Not to be used in
- Children and adolescents under 18 years of age.
- Active tuberculosis.
- People with severe infections, eg abscesses, leg ulcers.
- People with infection of the blood or body tissues with pus-forming or other pathogenic organisms (sepsis).
- People with infections due to lowered resistance of the body (opportunistic infections).
- Moderate to severe heart failure.
- Pregnancy.
- Breastfeeding.
This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
- There is no information about the safety of this medicine during pregnancy. It is not recommended for use during pregnancy as it could potentially be harmful to a developing baby. Women who could get pregnant should use an effective method of contraception to prevent pregnancy, both during treatment and for at least five months after their last injection. If you think you could be pregnant at any point during treatment you should tell your doctor straight away. Seek further medical advice from your doctor.
- It is not known if this medicine passes into breast milk, however it is possible that it does. It should only be used to treat women who are breastfeeding if the benefits to the mother outweigh any possible risk to the nursing infant. It is important to seek further medical advice from your doctor before breastfeeding if you are being treated with this medicine.
Side effects
Common
- Bacterial, viral or fungal infections, sometimes serious.
- Reactions such as pain, swelling, redness, bruising, bleeding or itching at the injection site.
- Decreased numbers of red blood cells, white blood cells or platelets in the blood.
- Headache.
- Fever.
- Increased blood pressure.
- Inflammation of the liver (hepatitis).
- Rash and itching of skin.
- Feeling sick.
Uncommon
- Allergic reactions.
- Infection of the blood or body tissues with pus-forming or other pathogenic organisms (sepsis).
- Cancer of solid organs.
- Benign tumours or cysts.
- Skin cancer or precancerous lesions.
- Anxiety.
- Mood changes.
- Inflammation of blood vessels.
- Dizziness.
- Eye disorders.
- Heart problems.
- Blood clot in a blood vessel (deep vein thrombosis or pulmonary embolism).
- Cough.
- Asthma.
- Skin reactions such as eczema, psoriasis, acne, discolouration, photosensitivity.
- Hair loss.
- Muscle disorders.
- Flu-like symptoms.
- Inflammation of the gut.
- Changes in menstrual cycle.
Rare
- Sexual problems.
- Sensation of ringing in the ears (tinnitus).
- Thyroid disorders.
- Lymphoma.
- Cancer of the gut.
- Mental disturbances, such as suicide attempts, delirium.
- Sarcoidosis.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
- It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.
- Certolizumab pegol is not recommended for use in combination with anakinra or abatacept, as this combination may increase the risk of serious infections, without an increase in efficacy against the disease treated.
- This medicine suppresses part of the immune system. This means that vaccines may potentially be less effective if given during treatment, and live vaccines may cause serious infections. Live vaccines include: measles, mumps, rubella, MMR, oral polio, oral typhoid and yellow fever. It is recommended that live vaccines are not given to people being treated with this medicine.
References:
https://www.rheumatology.org/Learning-Center/Medication-Guides/Medication-Guide-Certolizumab-Cimzia
https://www.netdoctor.co.uk/medicines/aches-pains/a8738/cimzia-certolizumab/
https://www.cimzia.com
https://www.cimzia.com/about-cimzia
https://www.medicines.org.uk/emc/product/4450/smpc
https://www.ema.europa.eu/en/medicines/human/EPAR/cimzia-0
https://www.versusarthritis.org/about-arthritis/treatments/drugs/certolizumab-pegol/
https://www.webmd.com/drugs/2/drug-150396/cimzia-subcutaneous/details
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