Risk of Serious Infections and Malignancy

• Patients treated with this drug are at risk of developing serious infections that may lead to hospitalization or death (see Warnings and Precautions). Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids.
• This drug should be discontinued if a patient develops a serious infection or sepsis.

  Reported Infections include:

• Active tuberculosis, including reactivation of latent tuberculosis. Patients with tuberculosis have frequently presented with disseminated or extrapulmonary disease. Patients should be tested for latent tuberculosis before certolizumab use and during therapy. Treatment for latent infection should be initiated prior to certolizumab use.
• Invasive fungal infections, including histoplasmosis, coccidiodomycoses, candidiasis, aspergillosis, blastomycosis, and pneumocystosis. Patients with histoplasmosis or other invasive fungal infections may present with disseminated rather than localized disease. Antigen and antibody testing for histoplasmosis may be negative in some patients with active infection. Empiric anti-fungal therapy should be considered in patients at risk for invasive fungal infections who develop severe systemic illness.
• Bacterial, viral and other infections due to opportunistic pathogens.
• The risks and benefits of treatment with certolizumab should be carefully considered prior to initiating therapy in patients with chronic or recurrent infection.
• Patients should be closely monitored for the development of signs and symptoms of infection during and after treatment with certolizumab, including the possible development of tuberculosis in patient who have tested negative for latent tuberculosis infection prior to initiating therapy (See Warnings and Precautions and Adverse Reactions sections of product insert).

Malignancy in Children and Adolescents

• Lymphoma and other malignancies, some fatal, have been reported in children and adolescent patients treated with TNF blockers, of which certolizumab pegol is a member.
• Certolizumab pegol is not indicated for use in pediatric patients