In addition to gout when else might xanthine oxidase inhibitors be used? • Hyperuricosuria (24-hour urine uric acid >1100 mg) due to risk of uric acid nephrolithiasis. • Prophylaxis against tumor lysis syndrome. • Hypoxanthine phosphoribosyltransferase deficiency (Lesch–Nyhan syndrome). • Hyperuricemia due to myeloproliferative disorders. • Hyperuricemia with nephrolithiasis of any type.
Can biologic agents be given during pregnancy and breastfeeding? TNF inhibitors and ustekinumab are FDA Pregnancy Classification B (old classification) medications. They can be used if clinically necessary for the mother’s health. It should be noted that only 4% of the maternal blood level of ETN is detected in the fetal circulation. Immunoglobulins do not …
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Can live vaccines be given to patients on biologics? No. Commonly used live vaccines include measles (MMR, Proquad), varicella (Varivax), oral rotavirus, Zostavax, and Flumist. Yellow fever, BCG, oral typhoid, and adenovirus (military personnel) are live vaccines given only to high-risk groups, whereas small pox and oral polio are rarely given today. Patients should be …
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What factors can make a patient less likely to respond to bDMARD therapy? Can two biologic agents be used together? Recent reports suggest that 5% to 10% of patients will fail three or more bDMARDs used to treat their underlying rheumatic disease. These patients are defined as being bDMARD-resistant. The most important factor is to …
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What are the indications, efficacy, and toxicities of belimumab (Benlysta)? • FDA-approved indication: SLE. Does not work in RA. • Available formulation: single-use vial containing 120 mg or 400 mg of lyophilized powder for reconstitution. A 200-mg/mL single-dose prefilled autoinjector or syringe is also available. • IV dosage: loading dose of 10 mg/kg IV at 0, 2, and …
What are the indications and toxicities of RTX (Rituxan)? • FDA-approved rheumatologic indications: RA after MTX and anti-TNF failure; ANCA-associated vasculitis (granulomatosis with polyangiitis [GPA], microscopic polyangiitis [MPA]). • Available formulation: single-use vial of 100 mg and 500 mg. • Dosage. RA: 1000-mg IV infusion repeated once 2 weeks later. Some physicians feel 500-mg dose is as effective …
Can more than one TNF inhibitor be tried in a patient? Any guidelines for switching? Most physicians and patients feel that at least a 50% overall clinical response is necessary to justify the cost and risk of using a TNF inhibitor. At least 50% of patients with RA, AS, or PsA may not achieve this …