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Many TNFis contain an Fc region, which can potentially be affected by high RF levels.6-10 Because RF binds to Fc fragments, higher RF levels may be associated with greater drug clearance of Fc-containing TNFis, resulting in lower active drug concentrations.5,6,11,12

Differences in TNFis may impact treatment outcomes in RA patients with high RF
Differences in TNFis may impact treatment outcomes in RA patients with high RF

These images are not meant to compare efficacy or safety. The clinical relevance is unknown.

Fab’=fragment antigen-binding; Fc=fragment crystallizable; IgG=immunoglobulin G; PEG=polyethylene glycol; TNF=tumor necrosis factor; TNFi=tumor necrosis factor inhibitor.

Figure adapted from Porter C, et al. Certolizumab pegol does not bind the neonatal Fc receptor (FcRn): Consequences for FcRn-mediated in vitro transcytosis and ex vivo human placental transfer. J Reprod Immunol. 2016;116:7-12, with permission from Elsevier.