Side effects observed with anti TNF α biologics? How can these toxicities be limited? 1. Injection site and infusion reactions. • All injectable TNF inhibitors: injection site reaction (up to 40% of patients) lasting 3 to 5 days. Some cause “bee sting” pain due to the preservative in the liquid. Treat with topical steroid or antihistamine. Rotate …
How are TNF inhibitors supplied and used for their FDA approved indications in rheumatic diseases? ETN (Enbrel). • Available formulations: single use 25-mg and 50-mg prefilled syringes; single use 50-mg SureClick autoinjector; single use 50-mg prefilled cartridge (Enbrel Mini) for use with reusable AutoTouch autoinjector; single use vial with 25 mg of lyophilized powder for reconstitution. …
Rationale behind the use of biologics to inhibit cytokines in various inflammatory diseases • TNF-α is initially expressed as a transmembrane molecule primarily on the surface of monocytes and macrophages. The extracellular portion is cleaved by TNF-α-converting enzyme to form a soluble molecule that circulates as a homotrimer. TNF-α (and TNF-β from T cells) binds to two …
precautions that should be taken before starting any biologics • Establish and record disease activity. • Screen for comorbidities: skin examination for malignancy, infection risk, human immune deficiency virus (HIV) risk factors, hepatitis B/C risk factors, history of malignancy (lymphoma, melanoma, others), history of demyelinating disease, history of tuberculosis (TB) or other mycobacterial infections, history of fungal …
precautions that should be taken before starting any biologics Read More »
What nomenclature is used in naming the biologics? • cept: receptor drug which prevents a ligand from binding to its receptor (e.g., ETN, abatacept, rilonacept). • ximab: chimeric monoclonal antibody (e.g., INF, RTX). • zumab: humanized monoclonal antibody (e.g., certolizumab, tocilizumab, ixekizumab, eculizumab). • umab: fully human monoclonal antibody (e.g., ADA, golimumab, belimumab, ustekinumab). • ra: receptor antagonist (e.g., anakinra).
What biologic agents (biologic disease-modifying antirheumatic drugs [bDMARDs]) are currently available for use in the treatment of inflammatory rheumatic diseases? With our increased understanding of the pathogenesis of autoimmune rheumatic diseases, several bDMARDs have been developed for treatment, especially for RA, ankylosing spondylitis (AS), psoriatic arthritis (PsA), juvenile idiopathic arthritis (JIA), cryopyrinopathies/cryopyrin-associated autoinflammatory syndromes (CAPS), …
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Biologics to treat Psoriatic arthritis Are there any other medications that may be available now or in the future to treat PsA? Numerous novel biologic therapies for PsA are in phase III trials including: Bimekizumab (a dual inhibitor of IL-17A and IL-17F), guselkumab and risankizumab (IL-23 inhibitors), and upadacitinib (JAK inhibitor). Additional biologic and small …