Certolizumab pegol/Cimzia

I've decided to give the medication its own page, as the effectiveness of this treatment is what I am hoping to document in my blog. Should this be successful, I'll be on this treatment for the rest of my life (excluding a brief period for pregnancy in the future). If I'm not responding, after 3 months of starting, I'll be changed to a different medication in the same group. I'll chop and change between cetrolizumab pegol and cimzia in this page. They are both the same things - one is the proper medical drug name, the other is the trade name (and is much shorter and easier to say and type).

What is Certolizumab pegol/Cimzia?  

Certolizumab pegol (commercial trade name 'Cimzia') is a type of drug known as anti-TNF (anti-tumour necrosis factor) and classified as biologic treatment. In the case of individuals with rheumatoid arthritis and other inflammatory diseases, a protein called TNF is overproduced in the body, causing inflammation and damage to bones, cartilage and tissue. Anti-TNF drugs block the action of TNF and so reduce this inflammation. It will not completely stop the production of TNF proteins as it is needed for the regulation of immune cells. Having no TNF proteins at all will make you significantly at risk to any infection of the immune system. The aim of this drug is to block the action of TNF proteins when they are produced. The drug will bind to the proteins rendering them inert. Since there is no way to get rid of the TNF proteins completely, you can never truly be cured of the rheumatoid arthritis but utilising these drugs can help to minimise the amount of damaging proteins and help to try and reduce inflammation and pain.

Why have I been prescribed this?

Certolizumab pegol is available for people with rheumatoid arthritis. It's also available for people with axial spondyloarthritis (that's me) and psoriatic arthritis (that's me too). If you have rheumatoid arthritis or psoriatic arthritis it will typically only be prescribed if your arthritis is active and if you’ve already tried methotrexate and another disease-modifying anti-rheumatic drug (DMARD) such as sulfasalazine or hydroxychloroquine, or if you can’t use these drugs for any reason. Non Steroidal Anti-Inflammatory Drugs [NSAIDS] (e.g. ibuprofen and naproxen) may also be prescribed in the first instance. As a result of my bowel condition, I was told to stop NSAIDS as it was enraging my stomach. In my case, my inflammation and pain was so bad that my rheumatologist made the executive decision to skip these and put me straight on the biologic therapy and I couldn't be more thankful. There are a number of reasons your doctor may not choose to put you on Cimzia including current infections, pregnancy or breast feeding, history of tuberculosis (TB), serious heart conditions or cancer.

How do I get this?/ How do I take this?

This medication is only available from a consultant rheumatologist. You can't buy this over the counter. Even when it was decided I was to start this treatment, I was referred to a specialist rheumatology nurse at the hospital to deal with my case. Once all her paperwork was signed, it was sent to BUPA who will have their own nurse come and see me, then show me how to take the medication. It's not a cheap option so they want to make sure that everything is in order before prescribing it. It’s taken by subcutaneous injection (an injection under the skin) into your thigh or midriff (fatty area of your tummy). You will have to learn to give injections yourself, or have a partner/family member do it for you. You could also arrange for a doctor or nurse to do it if you can't inject yourself for whatever reason. I'm not too bothered by the prospect so I'm happy to do it myself (and I can't time off work every two weeks for the rest of my life to have a doctor do it). 

Cimzia comes in a pre-filled syringe. Each pre-filled syringe contains 200 mg. The usual starting dose is 400 mg (two syringes) once every 2 weeks for the first three doses - called a loading dose and is shown to give patients a better response. After this, the dose is 200 mg (one syringe) every 2 weeks. Once all the treatment has been approved, it will be arranged for a courier to deliver the medication. It must be signed for on arrival and be placed straight into the fridge. Each delivery will have a 4 week supply (two syringes).

The company supplying my medication are kind enough to have a text alert system that will text me on the evening before or the day of giving me the estimated two hour time slot for my delivery so I can assure someone is in to sign for it. I chose to get the medication sent to my home address as I know typically there is someone in the house while I am at work. You can get it sent to your work address if required but you must have a fridge available to store it until you can take it home. They will also provide and collect sharps bins for disposal of syringes.

What are the potential side-effects? 

The most common side-effects are reactions at the injection site such as redness, swelling or pain, but these aren’t usually serious. Regularly changing the site of injection will help reduce your chances of this irritation. My nurse informed me that you are likely to get swelling at the site of injection as the liquid is very thick and gloopy in consistency which requires a slow injection. It should dissipate after an hour. 

Certolizumab pegol is an immunocomprimizing drug. It has effects on your immune system and so you may be more likely to develop infections. You should tell your doctor or rheumatology nurse specialist straight away if you develop any of the following after starting Cimzia: a sore throat, fever, diarrhoea and green phlegm (signs of infection). This drug can also affect your immunity to infections. It can make you susceptible to shingles and chicken pox, even if you have had chicken pox in the past and were previously immune. You should make active efforts to avoid anyone with serious infection (including children with chicken pox) and reduce your risk of infections from food (no pates, no unpasteurised dairy products, no soft French cheese, no blue cheese, no raw meat, try to avoid undercooked meat etc). Developing an infection with a weakened immune system can be serious and potentially fatal. There is also an increased risk of developing cancer.
 

The long-term side-effects of certolizumab pegol aren’t yet fully understood because it’s a relatively new drug. It is recommended you carry a 'Biological Therapy Alert Card' at all times when taking this treatment so anyone who treats you is aware of your current medication.

If you’re on cimzia it’s recommended that you avoid live vaccines, particularly yellow fever. However, in certain situations a live vaccine may be necessary (for example rubella vaccination in women of childbearing age), in which case your doctor will discuss the possible risks and benefits of the vaccination with you. Always consult a doctor before accepting any vaccinations. Pneumovax (which gives protection against the most common cause of pneumonia) and yearly flu vaccines don’t interact with certolizumab pegol and it is strongly recommend you start accepting them if offered while on biologic treatment.

Certolizumab pegol and Alcohol

You can drink alcohol while on certolizumab pegol (woohoo!) but drink sensibly and in moderation. If you are taking methotrexate at the same time, this isn’t recommended. I can’t comment as I am not taking methotrexate but if you are, consult your doctor. 

Certolizumab pegol and pregnancy
At present there is limited information on the use of certolizumab pegol during pregnancy and on how it might affect an unborn baby. Similarly, the effects of certolizumab pegol on men trying to father a child are uncertain.

Having spoken personally to my rheumatologist and rheumatology nurse, it has shown that Cimzia does not cross the placenta while pregnant and there should no risks to the unborn baby. It is recommend that I take Cimzia until I know I’m pregnant, if that is something I wish to do. As soon as I know I am pregnant, I’ve to see my nurse and consultant and they will stop the treatment until the baby is born/breast feeding in finished before starting the drug again. Generally, it's recommended that men and women use contraception while on this drug. As with other anti-TNF drugs, there may be an increased risk of infections in babies born to mothers using certolizumab pegol.

Generally, it's recommended that you don't breastfeed if you want to re-start certolizumab pegol after pregnancy as it's not known whether the drug may pass into your breast milk. However, limited studies of other anti-TNF drugs suggest that little or no drug gets into the breast milk. You should therefore discuss with your doctor whether to take certolizumab pegol whilst breastfeeding. As with other anti-TNF drugs, there may be an increased risk of infections in your baby if you use certolizumab pegol while breastfeeding and your baby then receives a live vaccine. Always consult everything in pregnancy with your specialist nurse and doctor.

As a mother with an immunocomprimized system, you will be at risk of the live vaccines your baby will typically receive at around 6 months and 18 months. Your nurse and doctor will no doubt talk about this at the time. As I am of childbearing age, I discussed this with my nurse at the time of starting the drug.

Certolizumab pegol and other drugs

Certolizumab pegol may be prescribed along with other drugs, including methotrexate. You should discuss any new medications with your doctor before starting them, and you should always tell any other doctor treating you that you’re taking certolizumab pegol. You should also be aware of the following points:

• Certolizumab pegol isn’t a painkiller. If you’re already on a non-steroidal anti-inflammatory drug (NSAID) or painkillers you can carry on taking these as well as certolizumab pegol, unless your doctor advises otherwise. If certolizumab pegol works for you, you may be able to reduce your NSAIDs or painkillers after a time.

•  Don’t take over-the-counter preparations or herbal remedies without discussing this first with your doctor, rheumatology nurse specialist or pharmacist.(though anyone who knows me will be aware of my dislike towards herbal and alternative therapies)
   

I've tried to cover most of the basic information here. You can find more information at the Certolizumab pegol page at Arthritis Research UK. If you are a sufferer of arthritis, you can ask for information from your consultant or specialist nurse.

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