Certolizumab Pegol

Certolizumab is used to treat inflammatory types of arthritis, such as rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS).

For RA and PsA, certolizumab may be used as monotherapy or in combination with DMARD therapy, such as methotrexate (MTX).

Certolizumab may be used as monotherapy for treatment of AS that has not responded to DMARD therapy.

Certolizumab is delivered by subcutaneous (s.c.) injection (meaning in the fatty layer of tissue just under the skin).

The starting dose of certolizumab is 400 mg, given once immediately then again at weeks two and four. This is followed by a maintenance dose of 200 mg given once every two weeks. In some cases, a 400 mg dose may be prescribed once a month.

The medication comes in single-use pre-filled syringes for administration.

In some people with arthritis, a signalling protein called a tumour necrosis factor (TNF) is present in the blood and joint in excessive amounts where it increases inflammation. Certolizumab works by suppressing the body’s immune system, specifically it binds to tumour necrosis factor and prevents it from causing inflammation. By doing this, certolizumab can help to reduce pain and swelling in the joints, improve day-to-day function, and prevent long term damage to the joints.

As with all of the biologics, you may not feel the effects of certolizumab right away. Some people begin to feel its effects fairly quickly; however, it may take three to six months to feel its full effect. It is important to be patient and keep taking your medication.

To provide symptom relief while you are waiting for certolizumab to take effect, your healthcare provider may recommend taking a steroid, such as prednisone, or a non-steroidal anti-inflammatory drug (NSAID).

Taking certolizumab can make it more difficult for your body to fight infections. Therefore, people with active infections should not take certolizumab. If you have a fever, think you have an infection or have been prescribed an antibiotic, contact your healthcare provider. People who have had frequent infections in the past or a history of tuberculosis should discuss the use of certolizumab with their healthcare provider. 

Also contact your healthcare provider if you are having surgery as you may need to stop certolizumab until you are healed and there is no sign of infection.

During pregnancy the risk of drug therapy for the child should be weighed against the risk of untreated inflammatory disease for the pregnant parent and child. Data suggests that certolizumab does not pose significant fetal risk and the medication may be considered for use throughout pregnancy. Low transfer to breast milk has also been shown with certolizumab and the medication is considered to be compatible with breastfeeding/chestfeeding. Please tell your healthcare provider if you are pregnant or planning to get pregnant before starting certolizumab.

People who have had a previous allergic reaction to certolizumab should avoid the medication.

Anyone with a history of cancer or nervous system problems, such as multiple sclerosis, should discuss the use of certolizumab with their healthcare provider.

Certolizumab may make a condition called congestive heart failure worse. Tell your doctor if you have congestive heart failure.

Before starting this medication, you will likely be tested for inactive (“latent”) tuberculosis (TB) and hepatitis B because certolizumab can dampen the immune system and cause these infections to become active. If TB or hepatitis is found, it will need to be treated before you start certolizumab. 

Make sure that your vaccinations are up to date before starting certolizumab. Your healthcare provider will likely recommend a number of vaccines (e.g., influenzae, pneumonia, RSV, shingles) to get beforehand. Because certolizumab can reduce your ability to react to vaccines, you should wait at least two to three weeks after your vaccine before starting certolizumab. If you are already on certolizumab and need a vaccination, try to space it as long as you can after your last dose.  Live vaccines are not recommended due to risk of causing infection. Before receiving any vaccinations while taking certolizumab, you should speak with your healthcare provider.

As with all medications, taking certolizumab carries some risk of side effects, which must be balanced with the potential benefits. In general, the risk of joint damage and permanent disability (resulting from arthritis) is much greater than the risks of side effects from certolizumab. When monitored properly the vast majority of side effects are rare and most improve over time and are reversible.

Certolizumab can increase your risk of infections. You should take precautions to minimize your risk of being infected by common contagious infections such as COVID-19, influenzae, pneumonia, and the common cold.

In rare cases, certolizumab can cause a reaction (redness, pain and itching) at the injection site. Talk to your healthcare provider if these symptoms become severe.

Also in unusual circumstances, some people may experience headaches with certolizumab. If this becomes severe, please speak with your healthcare provider.

Some people have developed lupus-like symptoms that disappeared after the medication was stopped. If you have chest pains that do not go away, shortness of breath or a rash on your cheeks or arms that gets worse in the sun, call your doctor right away.

There have been rare cases of disorders that affect the nervous system of people taking certolizumab or other TNF-blockers. Signs that you could be experiencing a problem affecting your nervous system include numbness or tingling, problems with your vision, weakness in your legs, and dizziness.

Certolizumab very rarely can cause a drop in blood counts.

Take certolizumab as prescribed and contact your healthcare provider if you have any concerns while taking the medication.

To avoid injection reactions, injection sites should be rotated and avoid areas where the skin is tender, bruised, red and/or hard.

Blood tests are not routinely required while you are taking certolizumab. Your healthcare provider may order periodic blood tests to check your blood count and follow the activity of your arthritis.

Certolizumab must be refrigerated at 2 to 8 degrees Celsius until you are ready to use it. Keep the product in the original package and out of the light.

Certolizumab must be kept cool while travelling. Ask your pharmacist for a cool carrier if you are not able to put the drug in your refrigerator right away.

The patient support program for Cimzia is called “Cimzia Solutions”. Their phone number is 1-800-908-5555.