Therapeutics - RA 4
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What is the benefit of combining Methotrexate with a TNF-alpha inhibitor?
- Slower radiographic progression
- Greater efficacy
What laboratory monitoring is required with Etanercept?
What is a usual dose of Etanercept?
- 50 mg SQ weekly
- 25 mg SQ 2x weekly
What are the adverse effects of Etanercept?
- Injections ite rxns
- HF exacerbation
- Demyelinating syndromes
How is Etanercept administered?
- Must be at RT for 15-30 minutes prior to administration
How is Etanercept stored?
What are the dosage forms for Etanercept?
Prefilled syringe, autoinjector, or multi-dose vial
What disease state might implicate use of Etanercept for RA treatment?
Which RA drugs need to be refrigerated?
What is a usual dose of Infliximab?
- 3 mg/kg IV
- Inject at 0, 2 and 6 weeks then Q8 weeks
Infliximab MUST be given with what other drug to treat RA?
What are the AE of Infliximab?
- Infusion reactions
- Autoantibodies (increase infusion rxns and decrease efficacy)
- Lupus like syndrome
- Worsening or new HF
How can you help prevent infusion reactions with Infliximab?
- Slow infusion rate
- Give acetaminophen, diphenhydramine or corticosteroids
Why do you have to give methotrexate with Infliximab and Golimumab but not Adalimumab?
- Adalimumab has no association with autoantibodies like infliximab does
- IgG antibody that is less antigenic
- No foreign protein
What is the usual dose of Adalimumab?
40 mg SQ x 14 days
What is the onset of symptom relief for adalimumab?
What dosage forms does Adalimumab come in?
Prefilled syringe and syringe
Golimumab is used with or without methotrexate?
What dosage forms does Golimumab come in?
Prefilled syringe and syringe
How is Golimumab injected?
At room temperature
What is the usual dose of Golimumab?
- 50 mg SQ Monthly
- 2 mg/kg IV over 30 minutes repeat 4 weeks later then Q8 weeks
Which biologic may be yellow in color?
What is the usual dose of Certolizumab?
- 400 mg SQ at 0, 2 and 4 weeks
- Then, 200 mg every other week
What dosage forms are available for Certolizumab?
Prefilled syringe or multiple dose vial
What drugs should Abatacept not be used with?
What is the onset of symptom relief for Abatacept?
When is it recommended to give Abatacept?
After at least one TNF – Alpha inhibitor has failed
What are the AEs of abatacept?
- Infusion related rxns
- Antibody formation
- Respiratory events
What patients will have a higher number of respiratory AEs when using Abatacept?
Should Abatacept be combined with TNF alpha inhibitors?
No, only leads to more infections, no greater efficacy
Combination of Abatacept and what other drug increases remission rates?
By what route is Abatacept given?
What group is Abatacept reserved for?
Patients who failed on or are CI to TNF alpha inhibitors
Do biologics or conventional RA therapies require more monitoring?
What is a usual dose of Rituximab?
- 4 mg/kg IV Q4 weeks
- May increase to 8 mg/kg
- Max = 800 mg
What is the onset of symptom relief for Rituximab?
What are the adverse effects of Rituximab?
- GI perforation
What lab monitoring is needed for treatment with Rituximab?
When should Rituximab be avoided?
When LFTs are > 1.5 x the upper limit of normal
Tocilizumab comes in what dosage forms?
IV and SQ
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