Infliximab Anakinra

Live vaccines should not be given to patients undergoing treatment with infliximab. Serious infection and neutropenia is predicted to occur if infliximab is given with anakinra. Infliximab may increase serum levels of azathioprine metabolites, and a rare T-cell lymphoma has been reported in adolescents and young adults treated with infliximab and also given azathioprine or mercaptopurine. Serum levels of infliximab appear to be unaffected by aminosalicylates, corticosteroids, ciprofloxacin or metronidazole. 

Several pro-inflammatory cytokines, such as TNFa, IL-1, IL-6, are important in the initiation and maintenance of various autoimmune diseases, such as RA, CD, and psoriasis. Thus, targeted therapies, which have been developed to inhibit their activity, have resulted in clinical improvement of these patients. Currently, there are three TNFa inhibitors (etanercept, infliximab, and adalimumab) and one IL-1 receptor antagonist (anakinra) that have been approved for the treatment of at least one of these diseases. In addition, a number of other anti-cytokine therapies are in clinical development. The TNFa antagonists will be reviewed here. 

Serious infections were seen in clinical studies with concurrent use of anakinra and another TNF -blocking agent, etanercept, with no added clinical benefit compared with etanercept alone. The combination of infliximab and anakinra is not recommended. 

Concurrent administration of etanercept (another TNF -blocking agent) and anakinra (an interleukin-1 antagonist) has been associated with an increased risk of serious infections, and increased risk of neutropenia and no additional benefit compared with these medicinal products alone. Other TNF -blocking agents (including infliximab) used in combination with anakinra also may result in similar toxicities. 

ANAKINRA ANTICANCER AND IMMUNOMODULATING DRUGS-ADALIMUMAB, ETANERCEPT, INFLIXIMAB t risk of bone marrow suppression Additive effect Avoid co-administration... 

DMARDs methotrexate, etanercept, infliximab, anakinra, and others... 

Cytokine inhibitors Etanercept, infliximab, adalimumab, anakinra... 

Infliximab inhibits the activity of tumour necrosis factor (TNFa). In clinical studies the use of anakinra with another TNFa inhibitor, etanercept , (p.l062) has been associated with an increased risk of serious infection and neutropenia and no additional benefit, when compared to the use of... 

Immunologic An IgE-mediated anaphylactic reaction has been attributed to anakinra in a 46-year-old Indian woman with rheumatoid arthritis who had had an urticarial rash and infusion reactions after three doses of infliximab, and autoantibodies, worsening Raynaud s phenomenon, and digital microinfarcts after treatment with etanercept for 1 year [83 ]. Skin prick tests were positive to both anakinra and histamine. She then had an urticarial reaction to adalimumab. 

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