TNF blockers

TNF blockers Rheumatoid arthritis and psoriasis Enbrel, Remicade, Humira, Rituxan... 

Malignancies In the controlled portions of clinical trials of all the TNF-blocking agents, more cases of lymphoma have been observed among patients receiving the TNF blocker compared with control patients. 

Etanercept (Enbrel) [Antirheumatic/TNF Blocker] Uses Reduces Sxs of RA in pts who fail other DMARD, Crohn Dz Action Binds TNF Dose Adults. RA 50 mg SQ wkly or 25 mg SQ 2x/wk (separated by at least 72-96 h) Feds 4-17 y. 0.8 mg/kg/wk (max 50 mg/wk) or 0.4 mg/kg (max 25 mg/dose) twice wkly 72-96 h apart Caution [B, ] w/ predisposition to Infxn (ie, DM) Contra Active Infxn Disp Inj SE HA, rhinitis, inj site Rxn, URI Interactions X Response to live virus vaccine EMS None OD Unlikely to cause life-threatening Sxs... 

No drug interaction studies have been conducted in humans. Animal studies indicate no change in the clearance or toxicity of either methotrexate or anakinra when the two agents are administered together. Concomitant administration of a TNF blocker appears to increase the risk of serious infection. The response to vaccines may be diminished in patients taking anakinra. 

Tumor necrosis factor (TNF) blockers for juvenile arthritis may lead to cancers in children and young adults.57... 

Abatacept (Orencia) [Immunomodulator] Uses Mod/severe RA w/ inadequate response to one or more DMARDs Action Selective costimulation modulator, T-cell activation Dose Initial 500 mg (<60 kg), 750 mg (60-100 kg) 1 g (>100 kg) IV over 30 min repeat at 2 and 4 wk, then q4wk Caution w/ TNF blockers [C, /-] COPD Hx recurrent/localized/chronic, predisposition to Infxn Contra w/ TNF antagonists (Enbrel, Remicade, Humira) (T Infxn) Disp IV powder SE HA, URI, N, nasopharyngitis, Infxn, malignancy, inf Rxns/hypersensitiv-ity (dizziness, HA, HTN), COPD exacerbations, cough, dyspnea Interactions May X effective OF live vaccines EMS May worsen COPD Sxs OD Monitor for adverse Rxn symptomatic and supportive... 

The potential role of TNF-blocking therapy in the development of malignancies is not known. Rates in clinical trials of Remicade cannot be compared to rates in clinical trials of other TNF-blockers and may not predict rates observed in a broader patient population... 

Increased risk of serious infection with leflunomide and TNF blockers... 

People with moderate to severe active rheumatoid arthritis who have not been helped by TNF blockers might consider abatacept, which is administered IV monthly. Side effects may include headache, nausea, and mild infections, such as upper respiratory tract infections. Serious infections, such as pneumonia, can occur. There is some concern that blocking of the suppressive signal from B7 to CTLA-4 may have a negative effect on regulatory T cells and, thus, eventually, promote autoimmunity. 

TNF blocker for moderate-to-severe rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis,... 

Musculoskeletal INH-induced interstitial pneumonia can occur during the course of anti-TB chemoprophylaxis in patients with rheumatoid arthritis who are at an increased risk for TB during the TNF-blocker treatment. 

---