Cimzia
Cimzia (certolizumab) is an injection that's used to treat many autoimmune conditions, such as rheumatoid arthritis, psoriasis, and Crohn's disease. This medication is given every 2 to 4 weeks. It can be used by itself or together with other medications, such as methotrexate. Side effects of Cimzia (certolizumab) include upper respiratory infections, urinary tract infections, and skin rash.
What is Cimzia (certolizumab)?
What is Cimzia (certolizumab) used for?
Moderate-to-severe Crohn's disease
Moderate-to-severe rheumatoid arthritis (RA)
Moderate-to-severe plaque psoriasis (PsO)
How Cimzia (certolizumab) works
Cimzia (certolizumab) is a type of biologic disease-modifying antirheumatic drug (DMARD). More specifically, it's a tumor necrosis factor (TNF) blocker. TNF is a protein in the body that plays a key role in inflammation. By blocking TNF, Cimzia (certolizumab) lowers inflammation in your body to treat symptoms caused by autoimmune conditions.
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What are the side effects of Cimzia (certolizumab)?
Common Side Effects
- Upper respiratory infections (common cold, throat infection; 18%)
- Rash (9%)
- Urinary tract infections (8%)
Other Side Effects
- Headache
- Pain, swelling, or redness at the injection site
- Cough
- Fever
- Hives
- Herpes infection
Serious Side Effects
- Serious infections: fever, difficulty breathing, cough, weakness, sweating, chills, diarrhea, stomach pain, burning when you urinate, urinating more frequently
- Heart failure: shortness of breath; swelling in the legs, ankles, or feet; irregular heartbeat; inability to exercise; tiredness; weakness
- Possible signs of cancer: loss of appetite; fatigue; lumps on skin; swollen lymph nodes in your neck, armpits, or groin; weight loss; nosebleeds
- Allergic reactions: hives, itching, swelling of face or tongue, difficulty breathing
Source: DailyMed
More on Cimzia (certolizumab) side effects
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Bladder pain
bloody or cloudy urine
body aches or pain
chills
difficult, burning, or painful urination
difficulty with breathing
ear congestion
frequent urge to urinate
headache
hoarseness
loss of voice
lower back or side pain
unusual tiredness or weakness
Less common
Bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
bloating or swelling of the face, arms, hands, lower legs, or feet
pain in the arms, ankles, knees, or legs
painful, red lumps under the skin, mostly on the legs
rapid weight gain
stomach pain
tingling of the hands or feet
tightness in the chest
unusual weight gain or loss
Rare
Blurred vision
confusion
coughing or spitting up blood
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fainting
feeling of warmth
general feeling of discomfort, illness, or weakness
itching, skin rash
joint pain or swelling
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
loss of appetite
muscle aches
night sweats
redness of the face, neck, arms, and occasionally, upper chest
sudden high fever or low-grade fever for months
sweating
swelling of the lymph glands
weakness
Incidence not known
Blistering, peeling, or loosening of the skin
red skin lesions, often with a purple center
red, irritated eyes
red, scaling, or crusted skin
sores, ulcers, or white spots in the mouth or on the lips
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Vomiting
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Cimzia (certolizumab)
Pros
Can use for many autoimmune conditions
Only need to inject every 2 to 4 weeks
Available as a prefilled syringe for easier use
Can store prefilled syringe at room temperature for up to 7 days, if needed
Cons
Can raise your risk of infection
Might be difficult for some people to administer properly
Hasn't been studied in children younger than 18 years old
Pharmacist tips for Cimzia (certolizumab)
You should receive training from your provider or pharmacist on how to inject Cimzia (certolizumab) safely and properly. Read the instructions for use or watch the instructional video to review how to use the medication. Contact your provider or pharmacist if you have any questions.
Keep the Cimzia (certolizumab) prefilled syringes in the carton to protect them from light, and place the cartons in the refrigerator. If you're traveling and don't have access to a refrigerator, you can keep the prefilled syringes at room temperature for up to 7 days. Once the medication has been out at room temperature, don't place it back in the refrigerator.
Before it's time for your dose, take the prefilled syringe out of the refrigerator, and lay it on a flat surface to warm up. This will take about 30 minutes. Don't try to warm up the medication any other way.
Cimzia (certolizumab) comes as two 200 mg prefilled syringes in a carton. If your dose is 400 mg, you'll need to give yourself two 200 mg injections.
Use a different place on your thigh or stomach each time you inject the medication. Inject Cimzia (certolizumab) at least 1 inch away from the last place you used to help prevent bruising or skin irritation. If you're injecting the medication into your stomach, make sure to inject at least 2 inches from your belly button.
After injecting Cimzia (certolizumab), throw the needle and syringe away in a sharps container or something made of heavy-duty plastic, such as an empty milk carton or laundry detergent bottle. This helps lower the risk of needle-stick injuries. Don't throw away needles or syringes in your trash can. For guidance on how to throw away your sharps container safely for your specific state, visit the FDA's website.
Cimzia (certolizumab) can raise your risk of getting a serious or life-threatening infection. If you develop symptoms of an infection (e.g., fever, cough, difficulty breathing, diarrhea, weakness, sweating, chills) while taking Cimzia (certolizumab), go to the hospital right away so you can get tested for an infection. You might have to stop taking Cimzia (certolizumab) so your body can fight the infection.
Make sure to tell your provider about all the medications you're taking before and during treatment with Cimzia (certolizumab). Examples of medications that shouldn't be taken with Cimzia (certolizumab) are Kineret (anakinra), Orencia (abatacept), Rituxan (rituximab), or Tysabri (natalizumab). They can raise your risk of serious infections. Also, don't take Cimzia (certolizumab) with other TNF blockers like Remicade (infliximab) or Enbrel (etanercept). Taking more than one TNF blocker at the same time can raise your risk of side effects and might not control your symptoms any better.
Frequently asked questions about Cimzia (certolizumab)
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What are the risks and warnings for Cimzia (certolizumab)?
Cimzia (certolizumab) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Serious infections
Risk factors: Active, chronic, or recurrent infection | Age 65 years and older | Having other conditions that raise your risk of infection | Living in or traveling to places with high rates of TB or fungal infections | Taking medications that weaken your immune system (e.g., steroids, methotrexate)
Cimzia (certolizumab) can affect your body's ability to fight off infections. This raises your risk of serious or life-threatening bacterial, viral, or fungal infections. The risk is higher for people who have an active infection, people who have infections that keep coming back, and adults aged 65 years and older. People with certain health conditions that make it easier to develop infections and people taking medications that weaken the immune system (e.g., steroids, methotrexate) are also at greater risk.
Treatment with Cimzia (certolizumab) can also cause new or old tuberculosis (TB) infections to come back. Similarly, the medication can reactivate the hepatitis B virus (HBV) if you're a carrier of the virus.
For these reasons, you'll need to get tested for both TB and HBV before starting Cimzia (certolizumab) and get treatment if you test positive (meaning you're infected with TB or HBV).
If you develop symptoms of an infection (e.g., fever, cough, difficulty breathing, diarrhea, weakness, sweating, chills) while taking Cimzia (certolizumab), go to the hospital right away so you can get tested for an infection. You might have to stop taking Cimzia (certolizumab) so your body can fight the infection. Tell your provider about your medical conditions and medications so they can make sure Cimzia (certolizumab) is safe for you.
Cancer
Risk factors: Age 18 years old and younger | Taking medications that weaken your immune system (e.g., mercaptopurine, azathioprine (Imuran)) | History of cancer | Rheumatoid arthritis
Cimzia (certolizumab) might raise your risk of getting certain types of cancers, including leukemia, lymphoma, or skin cancer. The risk is higher in people 18 years old and younger, if you take other medications that weaken your immune system (e.g., mercaptopurine, azathioprine (Imuran)), if you've had cancer before, or if you have rheumatoid arthritis. You'll probably need certain blood tests and occasional physical exams while you take Cimzia (certolizumab) so your provider can keep checking your risk of cancer. Contact your provider if you experience symptoms such as swollen lymph nodes in your neck, armpits, or groin, fatigue, weight loss, loss of appetite, recurrent nosebleeds, or lumps on your skin.
Heart failure
Risk factors: History of heart failure
Some people have had new or worsening heart failure while taking Cimzia (certolizumab). Let your provider know if you currently have heart failure. Contact your provider if you have any signs of heart failure, such as shortness of breath, swelling in the legs or feet, irregular heartbeat, problems exercising, tiredness, or weakness, while taking Cimzia (certolizumab).
Nervous system problems
Risk factors: History of a neurologic problem
Although rare, TNF blockers like Cimzia (certolizumab) have been linked to new or worsening nervous system problems. These problems can include seizures, nerve damage, and multiple sclerosis. Tell your provider if you have any neurological problems before starting Cimzia (certolizumab). Also let your provider know if you get dizziness, muscle weakness or spasms, changes in vision, or loss of balance while you're taking Cimzia (certolizumab).
Low blood cell counts
Although rare, people taking TNF blockers like Cimzia (certolizumab) have reported having low blood cell counts. This can raise the risk of serious infections, bleeding, and anemia. If your blood counts drop too low, you'll probably need to stop taking Cimzia (certolizumab). If you develop any signs of infection (e.g., fever, tiredness, chills, cough, trouble breathing) or signs of blood problems (pale skin, fast heart rate, lightheadedness, blood in your urine or stool), contact your provider right away.
Allergic reactions
Risk factors: Known latex allergy
Though rare, some people taking Cimzia (certolizumab) have had allergic reactions to the medication. These reactions can include rash, hives, trouble breathing, swelling of the face or lips, and anaphylaxis. Get medical help right away if you experience an allergic reaction to Cimzia (certolizumab).
In addition, the shield that protects the needle inside the removable cap of the Cimzia (certolizumab) prefilled syringe contains an ingredient that's very similar to natural rubber latex. If you're allergic to latex, contact with this needle shield can cause an allergic reaction. Let your provider know if you're allergic to latex and what your reaction to latex is.
Cimzia (certolizumab) dosage forms
Typical dosing for Cimzia (certolizumab)
Crohn's disease: The typical starting dose is 400 mg injected under the skin every 2 weeks for 3 doses. If Cimzia (certolizumab) works well for you after those fist few doses, then you'll switch to a maintenance dose of 400 mg every 4 weeks to control your symptoms.
Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and non-radiographic axial spondyloarthritis: The typical starting dose is 400 mg injected under the skin every 2 weeks for 3 doses. Afterwards, you'll switch to a maintenance dose of 200 mg every 2 weeks or 400 mg every 4 weeks.
Plaque psoriasis: The typical dose is 400 mg injected under the skin every 2 weeks. If you weigh 198 lbs or less, your provider might consider an alternative dosing schedule (400 mg injected under the skin every 2 weeks for 3 doses, then 200 mg every 2 weeks).
Interactions between Cimzia (certolizumab) and other drugs
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abatacept
- Adenovirus Vaccine Type 4, Live
- Adenovirus Vaccine Type 7, Live
- Anakinra
- Bacillus of Calmette and Guerin Vaccine, Live
- Dengue Tetravalent Vaccine, Live
- Infliximab
- Influenza Virus Vaccine, Live
- Measles Virus Vaccine, Live
- Mumps Virus Vaccine, Live
- Poliovirus Vaccine, Live
- Rotavirus Vaccine, Live
- Rubella Virus Vaccine, Live
- Smallpox Vaccine
- Tofacitinib
- Typhoid Vaccine, Live
- Varicella Virus Vaccine, Live
- Yellow Fever Vaccine
- Zoster Vaccine, Live
How much does Cimzia (certolizumab) cost?
What are alternatives to Cimzia (certolizumab)?
Moderate-to-severe Crohn's disease
Moderate-to-severe rheumatoid arthritis (RA)
Moderate-to-severe plaque psoriasis (PsO)
Rheumatoid arthritis (RA)
Plaque psoriasis (PsO) and psoriatic arthritis (PsA)
Ankylosing spondylitis (AS)
Childhood arthritis (polyarticular juvenile idiopathic arthritis, JIA)
Rheumatoid arthritis (RA) - adults only
Juvenile idiopathic arthritis (JIA) - people age 2 and older
Psoriatic arthritis (PsA) - adults only
Ankylosing spondylitis (AS) - adults only
Crohn's disease (CD) - people age 6 and older
Ulcerative colitis (UC) - people age 5 and older
Plaque psoriasis - adults only
Hidradenitis suppurativa (HS) - people age 12 and older
Uveitis - people age 2 and older
What is the latest news about Cimzia (certolizumab)?
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References
Best studies we foundCIMZIA. (n.d.). CIMZIA injections at home.
Clowse, M. E. B., et al. (2018). Pregnancy outcomes after exposure to certolizumab pegol: Updated results from a pharmacovigilance safety database. Arthritis & Rheumatology.
Drugs and Lactation Database (LactMed). (2023). Certolizumab pegol. National Institute of Child Health and Human Development.
Fleischmann, R., et al. (2009). Efficacy and safety of certolizumab pegol monotherapy every 4 weeks in patients with rheumatoid arthritis failing previous disease-modifying antirheumatic therapy: The FAST4WARD study. Annals of the Rheumatic Diseases.
Landewé, R., et al. (2014). Efficacy of certolizumab pegol on signs and symptoms of axial spondyloarthritis including ankylosing spondylitis: 24-week results of a double-blind randomised placebo-controlled Phase 3 study. Annals of the Rheumatic Diseases.
Leukemia & Lymphoma Society. (n.d.). Leukemia.
Leukemia & Lymphoma Society. (n.d.). Lymphoma.
Mease, P. J., et al. (2014). Effect of certolizumab pegol on signs and symptoms in patients with psoriatic arthritis: 24-week results of a Phase 3 double-blind randomised placebo-controlled study (RAPID-PsA). Annals of the Rheumatic Diseases.
MotherToBaby. (n.d.). MotherToBaby pregnancy studies.
UCB, Inc. (2017). First CIMZIA study of its kind showed minimal to no transfer of drug from mother's plasma to breast milk.
UCB, Inc. (2019). CIMZIA for injection, for subcutaneous use [package insert].
UCB, Inc. (2023). CIMZIA- certolizumab pegol kit. CIMZIA- certolizumab pegol injection, solution [package insert]. DailyMed.
U.S. Food and Drug Administration. (2021). Safely using sharps (needles and syringes) at home, at work and on travel.
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