TNF-α inhibitors (Infliximab, Adalimumab, Certolizumab)

• RA/IBD/spondyloarthropathy maintenance when csDMARDs insufficient

Monoclonal antibodies neutralising TNF-α → block downstream inflammatory cascade.

• Infliximab & adalimumab — full IgG1, active placental transfer ↑ sharply after ~20 weeks
• Certolizumab — Fc-free (PEGylated Fab), minimal to no active transfer (CRIB study)
• → Consider stopping infliximab/adalimumab in 3rd trimester; certolizumab can continue

Infliximab

3–10 mg/kg IV every 4–8 weeks (indication-dependent)

Adalimumab

40 mg SC every 2 weeks

Certolizumab

200–400 mg SC every 2–4 weeks

• AbsoluteActive serious infection / sepsis
• CautionLatent TB — screen before starting

• Injection-site reaction
• ↑ infection risk
• Rare demyelination

• • Live vaccines (e.g. BCG, rotavirus) should be deferred in infants exposed to infliximab/adalimumab in utero until ~6 months of age, due to a documented case of disseminated BCG infection after in-utero exposure.
• • Certolizumab infants have no comparable restriction given minimal placental transfer.
• • Compatible with breastfeeding for all three agents.

• Live vaccines

  Avoid

  Avoid in mother during treatment

• 💡 If anti-TNF therapy must continue into the third trimester, switching to (or continuing) certolizumab avoids the live-vaccine-timing complication seen with infliximab/adalimumab.