biologic immunosuppressive agent (biologic agent, biologic immune modulator)

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Introduction

A collective group of immunsuppressive agents.

Indications

Contraindications

* breast feeding apparently not a contraindication[5]

Laboratory

* antibiotic therapy must be started (& probably in most cases completed) prior to initiation of immunosuppressive agent

* also see ARUP consult[6]

Mechanism of action

Complications

  • all diminish resistance to infection
  • risk of cancer similar for DMARDs vs biologic agents in patients with rheumatoid arthritis[4]
  • biologic agent infusions administered at home, rather than at a facility, are associated with more adverse events requiring escalation of care[7]

Management

More general terms

More specific terms

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2022.
  2. 2.0 2.1 2.2 Singh JA, Furst DE, Bharat A 2012 Update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res, 64: 625-629 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22473917 <Internet> http://onlinelibrary.wiley.com/doi/10.1002/acr.21641/abstract
  3. 3.0 3.1 Vassilopoulos D, Calabrese LH Viral hepatitis: review of arthritic complications and therapy for arthritis in the presence of active HBV/HCV. Curr Rheumatol Rep. 2013 Apr;15(4):319. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23436024
  4. 4.0 4.1 Wadstrom H, Frisell T, Askling J et al. Malignant neoplasms in patients with rheumatoid arthritis treated with tumor necrosis factor inhibitors, tocilizumab, abatacept, or rituximab in clinical practice: A nationwide cohort study from Sweden. JAMA Intern Med 2017 Sep 18 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28975211
  5. 5.0 5.1 Matro R, Martin CF, Wolf D et al. Exposure concentrations of infants breastfed by women receiving biologic therapies for inflammatory bowel diseases and effects of breastfeeding on infections and development. Gastroenterology 2018 May 29 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29857090
  6. 6.0 6.1 ARUP Consult: Immunosuppressive Drug Optimization and Monitoring - Organ Transplantation Drugs The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/organ-transplantation
  7. 7.0 7.1 Baker MC, Weng Y, Fairchild R et al Comparison of Adverse Events Among Home- vs Facility-Administered Biologic Infusions, 2007-2017. JAMA Netw Open. 2021;4(6):e2110268. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34081140 PMCID: PMC8176330 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780573
    Calip GS, Yerram P, Ascha MS Nonrandomized Comparison of Adverse Events Following Facility- and Home-Infused Biologics Using Real-World Data. JAMA Netw Open. 2021;4(6):e2111156 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34081142 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2780575