Medically reviewed on Dec 24, 2018
(cer to LIZ u mab PEG ol)
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Kit, Subcutaneous [preservative free]:
Cimzia: 200 mg
Cimzia Prefilled: 200 mg/mL
Cimzia Starter Kit: 6 X 200 mg/mL
Brand Names: U.S.
- Cimzia Prefilled
- Cimzia Starter Kit
- Antirheumatic, Disease Modifying
- Gastrointestinal Agent, Miscellaneous
- Tumor Necrosis Factor (TNF) Blocking Agent
Certolizumab is a pegylated humanized antibody Fab’ fragment of tumor necrosis factor alpha (TNF-alpha) monoclonal antibody. Certolizumab binds to and selectively neutralizes human TNF-alpha activity. (Elevated levels of TNF-alpha have a role in the inflammatory process associated with Crohn disease and in joint destruction associated with rheumatoid arthritis.) Since it is not a complete antibody (lacks Fc region), it does not induce complement activation, antibody-dependent cell-mediated cytotoxicity, or apoptosis. Pegylation of certolizumab allows for delayed elimination and therefore an extended half-life.
Vss: 4.7 to 8 L
Time to Peak
Plasma: 54 to 171 hours
Special Populations Note
Body weight: Pharmacokinetic exposure is inversely related to body weight; however, no therapeutic benefit is expected from a weight-adjusted dose regimen.
Use: Labeled Indications
Ankylosing spondylitis: Treatment of adults with active ankylosing spondylitis (AS)
Crohn disease: Treatment of moderately to severely active Crohn disease in patients who have inadequate response to conventional therapy
Plaque psoriasis: Treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy
Psoriatic arthritis: Treatment of adult patients with active psoriatic arthritis
Rheumatoid arthritis: Treatment of adults with moderately to severely active rheumatoid arthritis (RA) (as monotherapy or in combination with nonbiological disease-modifying antirheumatic drugs [DMARDS])
Off Label Uses
Crohn disease (perianal/fistulizing disease)
Data from a post-hoc analysis of a randomized, double-blind, placebo-controlled trial evaluating the efficacy of certolizumab as maintenance therapy in adults with moderate to severe Crohn disease suggests that certolizumab may be beneficial for closure of perianal fistulas [Schreiber 2011].
Based on the American College of Gastroenterology Guideline for the Management of Crohn’s disease in Adults, certolizumab may be effective and should be considered in the management of perianal fistulas in patients with Crohn disease [ACG [Lichtenstein 2018]].
Hypersensitivity to certolizumab pegol or any component of the formulation
Canadian labeling: Additional contraindications (not in US labeling): Active tuberculosis or other severe infections (eg, sepsis, abscesses, opportunistic infections); moderate to severe heart failure (NYHA Class III/IV)
Note: Each 400 mg dose should be administered as 2 injections of 200 mg each.
Ankylosing spondylitis: SubQ: Initial: 400 mg, repeat dose 2 and 4 weeks after initial dose; Maintenance: 200 mg every 2 weeks or 400 mg every 4 weeks
Crohn disease: SubQ: Initial: 400 mg, repeat dose 2 and 4 weeks after initial dose; Maintenance: 400 mg every 4 weeks
Crohn disease (perianal/fistulizing disease) (off-label use): SubQ: Initial: 400 mg, repeat dose 2 and 4 weeks after initial dose; Maintenance: 400 mg every 4 weeks (Schreiber 2011)
Plaque psoriasis: SubQ: 400 mg every other week. Note: For patients ≤90 kg, an initial dose of 400 mg at weeks 0, 2, and 4 followed by 200 mg every other week thereafter may be considered.
Psoriatic arthritis: SubQ: Initial: 400 mg, repeat dose 2 and 4 weeks after initial dose; Maintenance: 200 mg every other week. May consider maintenance dose of 400 mg every 4 weeks.
Rheumatoid arthritis: SubQ: Initial: 400 mg, repeat dose 2 and 4 weeks after initial dose; Maintenance: 200 mg every other week. May consider maintenance dose of 400 mg every 4 weeks. May be administered alone or in combination with methotrexate.
Refer to adult dosing.
Dosing: Adjustment for Toxicity
Hypersensitivity, lupus-like syndrome, serious infection, sepsis, or hepatitis B reactivation: Discontinue treatment.
Vials: Allow vial to sit at room temperature for 30 minutes prior to reconstitution; do not warm in any other way. Reconstitute each vial with 1 mL sterile water for injection (provided) to a concentration of 200 mg/mL; the manufacturer recommends using a 20-gauge needle (provided). Direct sterile water for injection at the vial wall and gently swirl (avoid foaming) for about one minute to facilitate wetting of powder; do not shake. Continue swirling every 5 minutes until fully reconstituted (may take up to 30 minutes).
SubQ: Bring to room temperature prior to administration. After reconstitution (of vials), draw each vial into separate syringes (using 20-gauge needles).
Administer subcutaneously (using provided 23-gauge needle) into the abdomen or thigh. For a 400 mg (2 syringes) dose, administer each 200 mg syringe at a separate site; rotate injection sites. Do not administer to areas where skin is tender, bruised, red, or hard.
Prefilled syringes may be self-administered after proper training.
Store intact vials and syringes at 2°C to 8°C (36°F to 46°F); do not freeze. Do not separate contents of carton prior to use. Protect from light. Bring to room temperature prior to administration. Prefilled syringes may be stored at ≤25°C (≤77°F) for ≤7 days; write date removed from refrigerator and discard if not used within 7 days. Store in original carton (to protect from light) and do not return to refrigerator.
Store reconstituted solution for up to 24 hours at 2°C to 8°C (36°F to 46°F) (do not freeze); however, do not leave at room temperature for more than 2 hours prior to administration. Discard unused portion of vial or syringe.
Abatacept: Anti-TNF Agents may enhance the adverse/toxic effect of Abatacept. An increased risk of serious infection during concomitant use has been reported. Avoid combination
Anakinra: Anti-TNF Agents may enhance the adverse/toxic effect of Anakinra. An increased risk of serious infection during concomitant use has been reported. Avoid combination
Anti-TNF Agents: May enhance the immunosuppressive effect of Certolizumab Pegol. Avoid combination
Baricitinib: May enhance the adverse/toxic effect of Biologic Disease-Modifying Antirheumatic Drugs (DMARDs). Avoid combination
BCG (Intravesical): Immunosuppressants may diminish the therapeutic effect of BCG (Intravesical). Avoid combination
Canakinumab: Anti-TNF Agents may enhance the adverse/toxic effect of Canakinumab. Specifically, the risk for serious infections and/or neutropenia may be increased. Avoid combination
Coccidioides immitis Skin Test: Immunosuppressants may diminish the diagnostic effect of Coccidioides immitis Skin Test. Monitor therapy
Denosumab: May enhance the adverse/toxic effect of Immunosuppressants. Specifically, the risk for serious infections may be increased. Monitor therapy
Echinacea: May diminish the therapeutic effect of Immunosuppressants. Consider therapy modification
Fingolimod: Immunosuppressants may enhance the immunosuppressive effect of Fingolimod. Management: Avoid the concomitant use of fingolimod and other immunosuppressants when possible. If combined, monitor patients closely for additive immunosuppressant effects (eg, infections). Consider therapy modification
Leflunomide: Immunosuppressants may enhance the adverse/toxic effect of Leflunomide. Specifically, the risk for hematologic toxicity such as pancytopenia, agranulocytosis, and/or thrombocytopenia may be increased. Management: Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Patients receiving both leflunomide and another immunosuppressant should be monitored for bone marrow suppression at least monthly. Consider therapy modification
Natalizumab: Immunosuppressants may enhance the adverse/toxic effect of Natalizumab. Specifically, the risk of concurrent infection may be increased. Avoid combination
Nivolumab: Immunosuppressants may diminish the therapeutic effect of Nivolumab. Consider therapy modification
Ocrelizumab: May enhance the immunosuppressive effect of Immunosuppressants. Monitor therapy
Pegloticase: May diminish the therapeutic effect of PEGylated Drug Products. Monitor therapy
Pegvaliase-pqpz: PEGylated Drug Products may enhance the adverse/toxic effect of Pegvaliase-pqpz. Specifically, the risk of anaphylaxis or hypersensitivity reactions may be increased. Monitor therapy
Pidotimod: Immunosuppressants may diminish the therapeutic effect of Pidotimod. Monitor therapy
Pimecrolimus: May enhance the adverse/toxic effect of Immunosuppressants. Avoid combination
Rilonacept: Anti-TNF Agents may enhance the adverse/toxic effect of Rilonacept. Avoid combination
RiTUXimab: May enhance the immunosuppressive effect of Certolizumab Pegol. Avoid combination
Roflumilast: May enhance the immunosuppressive effect of Immunosuppressants. Consider therapy modification
Sipuleucel-T: Immunosuppressants may diminish the therapeutic effect of Sipuleucel-T. Monitor therapy
Tacrolimus (Topical): May enhance the adverse/toxic effect of Immunosuppressants. Avoid combination
Tertomotide: Immunosuppressants may diminish the therapeutic effect of Tertomotide. Monitor therapy
Thiopurine Analogs: Anti-TNF Agents may enhance the adverse/toxic effect of Thiopurine Analogs. Specifically, the risk for T-cell non-Hodgkin's lymphoma (including hepatosplenic T-cell lymphoma) may be increased. Monitor therapy
Tocilizumab: May enhance the immunosuppressive effect of Anti-TNF Agents. Avoid combination
Tofacitinib: Biologic Disease-Modifying Antirheumatic Drugs (DMARDs) may enhance the adverse/toxic effect of Tofacitinib. Avoid combination
Trastuzumab: May enhance the neutropenic effect of Immunosuppressants. Monitor therapy
Vaccines (Inactivated): Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Management: Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to starting an immunosuppressant. If vaccinated during immunosuppressant therapy, revaccinate at least 3 months after immunosuppressant discontinuation. Consider therapy modification
Vaccines (Live): Immunosuppressants may enhance the adverse/toxic effect of Vaccines (Live). Immunosuppressants may diminish the therapeutic effect of Vaccines (Live). Management: Avoid use of live organism vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants. Avoid combination
Vedolizumab: Anti-TNF Agents may enhance the adverse/toxic effect of Vedolizumab. Avoid combination
Tests for latent tuberculosis may be falsely negative while on certolizumab treatment. Falsely elevated aPTT assays have been reported with PTT-Lupus Anticoagulant (LA) and Standard Target Activated Partial Thromboplastin time (STA-PTT) tests from Diagnostica Stago, and with HemosiL APTT-SP liquid and HemosiL lyophilized silica tests from Instrumentation Laboratories.
Gastrointestinal: Nausea (≤11% [Schreiber 2005])
Immunologic: Antibody development (7% to 23%)
Infection: Infection (38%; serious: 3%)
Respiratory: Upper respiratory tract infection (6% to 20%)
1% to 10%:
Cardiovascular: Hypertension (≤5%), angina pectoris (<5%), atrial fibrillation (<5%), cardiac arrhythmia (<5%), cardiac failure (<5%; new or worsening), cerebrovascular accident (<5%), hypertensive heart disease (<5%), ischemic heart disease (<5%), myocardial infarction (<5%), pericardial effusion (<5%), pericarditis (<5%), transient ischemic attacks (<5%), vasculitis (<5%)
Central nervous system: Headache (5%), anxiety (<5%), bipolar mood disorder (<5%), suicidal tendencies (<5%), fatigue (≤3%)
Dermatologic: Skin rash (≤9%), alopecia (<5%), dermatitis (<5%), erythema nodosum (<5%), urticaria (<5%)
Endocrine & metabolic: Menstrual disease (<5%)
Genitourinary: Urinary tract infection (≤8%), nephrotic syndrome (<5%)
Hematologic & oncologic: Anemia (<5%), hemorrhage (<5%), hypercoagulability state (<5%), leukopenia (<5%), lymphadenopathy (<5%), pancytopenia (<5%), thrombophlebitis (<5%), positive ANA titer (≤4%)
Hepatic: Hepatitis (<5%), increased serum transaminases (<5%)
Neuromuscular & skeletal: Arthralgia (6% to 7%), back pain (≤4%)
Ophthalmic: Optic neuritis (<5%), retinal hemorrhage (<5%), uveitis (<5%)
Renal: Renal failure (<5%)
Respiratory: Cough (≤6%), nasopharyngitis (5%), tuberculosis (<5%; peritoneal, pulmonary, and disseminated), bronchitis (≤3%), pharyngitis (≤3%)
Miscellaneous: Fever (3%)
<1%, postmarketing, and/or case reports: Abdominal pain, aplastic anemia, autoimmune hepatitis (Shelton 2015), cytopenia, demyelinating disease (exacerbation), diarrhea, fistula, hepatosplenic T-cell lymphoma, herpes virus infection, hypersensitivity reaction (eg, allergic dermatitis, angioedema, dizziness [postural], dyspnea, hepatotoxicity (idiosyncratic) (Chalasani 2014), hot flush, hypotension, injection site reactions, malaise, serum sickness, syncope), intestinal obstruction, leukemia, limb pain, lupus erythematosus, lupus-like syndrome, lymphoma, malignant melanoma, malignant neoplasm, Merkel cell carcinoma, neoplasm (benign, malignant, and unspecified; including cysts and polyps), opportunistic infection (rare), peripheral edema, peripheral neuropathy, pneumonia, psoriasis (including new onset, palmoplantar, pustular, or exacerbation), pyelonephritis, reactivation of HBV, sarcoidosis, seizure, sensory disturbance, thrombocytopenia, viral infection, weakness
Concerns related to adverse effects:
• Autoimmune disorder: Autoantibody formation may develop; rarely resulting in autoimmune disorder, including lupus-like syndrome; monitor and discontinue if symptoms develop.
• Demyelinating CNS disease: Rare cases of optic neuritis, seizure, peripheral neuropathy, and demyelinating disease (eg, multiple sclerosis, Guillain-Barré syndrome; new onset or exacerbation) have been reported. Use with caution in patients with preexisting or recent-onset central or peripheral nervous system demyelinating disorders.
• Hematologic effects: Rare cases of pancytopenia and other significant cytopenias, including aplastic anemia, have been reported with TNF-blocking agents. Leukopenia and thrombocytopenia have occurred with certolizumab. Consider discontinuing therapy with significant hematologic abnormalities. Use with caution in patients with underlying hematologic disorders.
• Hepatitis B: Rare reactivation of hepatitis B virus (HBV) has occurred in chronic carriers of the virus, usually in patients receiving concomitant immunosuppressants; evaluate for HBV prior to initiation in all patients. Patients who test positive for HBV surface antigen should be referred for hepatitis B evaluation/treatment prior to certolizumab initiation. Monitor for clinical and laboratory signs of active infection during and for several months following discontinuation of treatment in HBV carriers; interrupt therapy if reactivation occurs and treat appropriately with antiviral therapy; if resumption of therapy is deemed necessary, exercise caution and monitor patient closely.
• Hypersensitivity: Hypersensitivity reactions, including angioedema, anaphylactoid reactions, dyspnea, hypotension, rash, serum sickness and urticaria have been reported (rarely) with treatment. Some of these reactions have occurred after the first dose. Discontinue and do not resume therapy if hypersensitivity occurs. Use with caution in patients who have experienced hypersensitivity with other TNF blockers.
• Immunogenicity: Development of antibodies to certolizumab during therapy may occur. Antibody-positive patients may have an increased incidence of adverse events (including injection site pain/erythema, abdominal pain, and erythema nodosum) and may have lower certolizumab concentrations with reduced efficacy.
• Infections: [US Boxed Warning]: Patients treated with certolizumab are at increased risk for developing serious infections, which may result in hospitalization or death; infections usually developed in patients receiving concomitant immunosuppressive agents (eg, methotrexate, corticosteroids) and may present as disseminated (rather than local) disease. Active tuberculosis (including reactivation of latent tuberculosis), invasive fungal (including aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, histoplasmosis, and pneumocystosis) and bacterial, viral, or other opportunistic infections (including legionellosis and listeriosis) have been reported in patients receiving certolizumab. Monitor closely for signs/symptoms of infection. Discontinue for serious infection or sepsis. Consider risks vs benefits prior to use in patients with a history of chronic or recurrent infection. Consider empiric antifungal therapy in patients who are at risk for invasive fungal infection and develop severe systemic illness. The elderly, patients with co-morbid conditions, and/or patients taking concomitant immunosuppressants may be at a greater risk of infection. Consider risks vs benefits prior to initiating therapy in patients with a history of opportunistic infection; patients who have resided or traveled in areas of endemic tuberculosis or endemic mycoses, such as histoplasmosis, coccidioidomycosis, or blastomycosis; and patients with underlying conditions, which may predispose them to infection. Do not initiate certolizumab therapy with active infection, including clinically important localized infection. Patients who develop a new infection while undergoing treatment should be monitored closely.
• Malignancy: [US Boxed Warning]: Lymphoma and other malignancies (some fatal) have been reported in children and adolescent patients receiving TNF-blocking agents. Certolizumab is not indicated for use in pediatric patients. Approximately half of the malignancies reported in children were lymphomas (Hodgkin and non-Hodgkin) while other cases varied and included malignancies not typically observed in this population. The onset of malignancy was after a median of 30 months (range: 1 to 84 months) after the initiation of the TNF-blocking agent. Use of TNF blockers may affect defenses against malignancies; impact on the development and course of malignancies is not fully defined. Chronic immunosuppressant therapy use may be a predisposing factor for malignancy development; rheumatoid arthritis alone has been previously associated with an increased rate of lymphoma. Hepatosplenic T-cell lymphoma (HSTCL), a rare T-cell lymphoma, has also been associated with TNF-blocking agents, including certolizumab, primarily reported in adolescent and young adult males with Crohn disease or ulcerative colitis, most of whom had received concurrent treatment with azathioprine and/or 6-mercaptopurine. Melanoma and Merkel cell carcinoma have been reported with TNF-blocking agents including certolizumab. Perform periodic skin examinations in all patients during therapy, particularly those at increased risk for skin cancer.
• Tuberculosis: [US Boxed Warning]: Tuberculosis (disseminated or extrapulmonary disease) has been reported; both reactivation of latent infection and new infections have been reported. Patients should be tested for latent tuberculosis infection before and during therapy; consider treatment of latent tuberculosis prior to certolizumab treatment. Monitor for development of tuberculosis during and after treatment, including patients with initial negative skin tests. Use with caution in patients who have resided in regions where tuberculosis is endemic. Consider antituberculosis treatment prior to initiation of certolizumab in patients with a history of latent or active tuberculosis if adequate treatment course cannot be confirmed, and for patients with risk factors for tuberculosis despite a negative test. Strongly consider tuberculosis in patients who develop a new infection during treatment, especially in patients who have previously or recently traveled to countries with a high prevalence of tuberculosis, or who have had close contact with a person with active tuberculosis.
• Heart failure: Use with caution in heart failure patients; worsening heart failure and new-onset heart failure have been reported with TNF blockers, including certolizumab; monitor closely. In a scientific statement from the American Heart Association, TNF blockers have been determined to be agents that may either cause direct myocardial toxicity or exacerbate underlying myocardial dysfunction (magnitude: major) (AHA [Page 2016]).
• Renal impairment: Use has not been studied in patients with renal impairment; however, the pharmacokinetics of the pegylated (polyethylene glycol) component may be dependent on renal function.
Concurrent drug therapy issues:
• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.
• Elderly: Use with caution in elderly patients, may be at higher risk for infections.
• Pediatric: Malignancies have been reported among children and adolescents receiving TNF-blocking agents.
Dosage form specific:
• Latex: The packaging (needle shield inside the removable cap of prefilled syringe) may contain a plastic derived from natural rubber latex.
• Immunizations: Patients should be up to date with all immunizations before initiating therapy; patients may receive vaccines other than live or live attenuated vaccines during therapy. There is no data available concerning the effects of therapy on vaccination or secondary transmission of live vaccines in patients receiving therapy.
Monitor improvement of symptoms and physical function assessments. Latent TB screening prior to initiating and during therapy; signs/symptoms of infection (prior to, during, and following therapy); CBC with differential; signs/symptoms/worsening of heart failure; HBV screening prior to initiating (all patients), HBV carriers (during and for several months following therapy); signs and symptoms of hypersensitivity reaction; symptoms of lupus-like syndrome; signs/symptoms of malignancy (eg, splenomegaly, hepatomegaly, abdominal pain, persistent fever, night sweats, weight loss) including periodic skin examinations.
The American Gastroenterological Association suggests reactive therapeutic drug monitoring to guide treatment changes in adult patients treated with certolizumab for active inflammatory bowel disease (Feuerstein 2017).
Certolizumab crosses the placenta (Förger 2016; Mariette 2018). Serum concentrations in 12 infants of 10 mothers were ≥75% lower than the maternal serum at delivery (last maternal dose of 400 mg given 5 to 42 days prior to birth). Although placental transfer was low, infants may have a slower rate of elimination than adults (Mahadevan 2013). The safety of administering live or live-attenuated vaccines to exposed infants is not known.
If a biologic agent such as certolizumab is needed to treat inflammatory bowel disease during pregnancy, it is recommended to hold therapy after 30 weeks gestation (Habal 2012). However, due to the low level of placental transfer compared to other biologic agents, certolizumab may be considered for use throughout pregnancy for rheumatic diseases when necessary (Götestam Skorpen 2016; Mariette 2018).
Health care providers are encouraged to enroll women exposed to certolizumab during pregnancy in the MotherToBaby Pregnancy Studies by contacting the Organization of Teratology Information Specialists (OTIS) (877-311-8972) or http://mothertobaby.org/pregnancy-studies/.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience signs of common cold. Have patient report immediately to prescriber signs of infection, signs of a urinary tract infection (hematuria, burning or painful urination, polyuria, fever, lower abdominal pain, or pelvic pain), signs of liver problems (dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or jaundice), signs of lupus (rash on the cheeks or other body parts, sunburn easy, muscle or joint pain, angina or shortness of breath, or swelling in the arms or legs), signs of aplastic anemia (fever, pharyngitis, mouth sores, infections, bruising, or purple skin splotches), chills, shortness of breath, signs of nerve problems (sensitivity to heat or cold; decreased sense of touch; burning, numbness, or tingling; pain, or weakness in the arms, hands, legs, or feet), severe dizziness, passing out, skin growth, skin lump, mole changes, vision changes, excessive weight loss, extremity weakness, night sweats, severe injection site irritation, burning or numbness feeling, signs of heart problems (cough or shortness of breath that is new or worse, swelling of the ankles or legs, abnormal heartbeat, weight gain of more than five pounds in 24 hours, dizziness, or passing out), seizures, pale skin, mood changes, or suicidal ideation (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
More about certolizumab
- Certolizumab Side Effects
- During Pregnancy or Breastfeeding
- Dosage Information
- Drug Interactions
- En Español
- 29 Reviews
- Drug class: TNF alfa inhibitors
- FDA Alerts (4)
Other brands: Cimzia