biologic immunosuppressive agent (biologic agent, biologic immune modulator)
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Introduction
A collective group of immunsuppressive agents.
Indications
- used as to treat rheumatologic disease
Contraindications
- active infection treated with antibiotics
- hold biologic immunosuppressive agent during antibiotic therapy[1]
- latent tuberculosis
- patients should be treated for at least 6 months before treatment with a biologic agent
- 2 biologic immunosuppressive agents used in combination not significantly more effective than either alone[1][2]
- coadministration of live virus vaccines[1]
- live virus vaccine may be administered 4 weeks prior to starting biologic immunosuppressive agent[1]
* breast feeding apparently not a contraindication[5]
Laboratory
- screening for tuberculosis, hepatitis B, hepatitis C & HIV1 infection prior to initiation of aggressive immunosuppressive therapy[1][2][3]*
* antibiotic therapy must be started (& probably in most cases completed) prior to initiation of immunosuppressive agent
Mechanism of action
- all specifically inhibit endogenous protein(s) involved in immunologic response (abatacept may be an exception)
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
- whenever possible bring patients up to date on vaccinations prior to initiating biologic immunosuppressive agent[1]
More general terms
More specific terms
- abatacept (Orencia)
- anakinra (Kineret)
- baricitinib (Olumiant)
- belimumab (Benlysta)
- canakinumab (Ilaris)
- guselkumab (Tremfya)
- rilonacept (Arcalyst)
- rituximab (Rituxan, Mabthera, Truxima, Ruxience, Riabni)
- sarilumab (Kevzara)
- tocilizumab; atlizumab (Actemra, RoActemra, Tofidence, Tyenne)
- tofacitinib (Xeljanz)
- tumor necrosis factor (TNF) inhibitor
- ustekinumab (Stelara, Wezlana, Pyzchiva, Selarsdi, Yesintek)
References
- ↑ Jump up to: 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.
- ↑ Jump up to: 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
- ↑ Jump up to: 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
- ↑ Jump up to: 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
- ↑ Jump up to: 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
- ↑ Jump up to: 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
- ↑ Jump up to: 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