What are biologic agents?
•Genetically engineered protein molecules block the proinflammatory cytokines
What are the 4 different groups of biologic agents?
–TNF-α (Adalimumab, etc)
–IL-6 (Tocilizumab, etc)
–Deplete B cells (Rituximab)
–Bind to CD80/86 on T cells to prevent activation of T cells (Abatacept)
What are the 5 TNF-α biologic agents?
What are the names of the 2 IL-6 biologics?
What is the mechanism of the TNF-α biologic DMARDS?
–Block the proinflammatory cytokins TNF-α
What is the 1 contraindication of the TNF-α biologic DMARDs?
The following are the ADEs of which group of biologic DMARDs?
–MS-like illness or exacerbate MS
–Increased risk of lymphoproliferative cancer
(limumab, Certolizumab, Entanercept, Golimumab, Infliximab)
Which TNF-α Biologic DMARD?
- Fusion protein
- Binds to TNF making it biologically inactive
Which TNF-α biologic DMARD?
- Chimeric antibody combining portions of mouse and human IgG1
What should be given concurrently w/ Inliximab?
What are the 3 uses of Golimumab (TNF-α biologic)
2. Psoriatic arthritis
3. Ankylosing spondylitis
The two IL-6 biologic DMARDS, Tocilizumab and Sarilumab, should be used in monotherapy or in combo with either of what 2 meds?
methotrexate or another non-biologic DMARD
ADEs of which biologic?
- Increased infection risk
- Elevated plasma lipids
- Elevated liver enzymes
- Risk of GI perforation
- Inducer of CYP450 3A4 (warfarin)
IL-6: Tocilizumab and Sarilumab
Should live vaccines be given during RA treatment with any of the biologics?
______ should be continued wtih Rituximab
Rituximab (B cell biologic) is indicated for what 2 reasons
–patients who have failed methotrexate or TNF-α
What 3 meds are given prior to Rituximab to reduce reaction?
ADEs of which med?
- HA, nasopharyngitis, cough
- back pain
- extremity pain
Abatacept (T cell biologic)
Which 4 vaccines can be given during RA therapy with Biologic DMARDs?
- IM influenza
- Hep B
T/F: Live vaccines can be given to patients already on DMARD therapy, but NOT biologics
For patients > 50y/o who will be starting a biologic or Tofacitinib, ACR recommends giving which vaccine?
Herpes Zoster vaccine
T/F: After failure of anti-TNF agent, subsequent tx may include trialing an alternative anti-TNF agent or changing to a non-TNF biologic