drug adverse effects of biologic immunosuppressive agents
Jump to navigation
Jump to search
Adverse effects
- increased risk for serious infection compared with traditional DMARDs
- 0.6% for standard-dose biological therapy
- 1.7% for high-dose biological therapy
- 5.5% for combination biological therapy[1]
- hold biologic immunosuppressive agent during antibiotic therapy
- increased risk for serious infections with adalimumab & infliximab compared with nonmethotrexate other DMARDs[2]
- no increased risk for serious infections with ustekinumab or etanercept[2]
- risk of cancer similar for DMARDs vs biologic agents in patients with rheumatoid arthritis[4]
* breast feeding apparently not a contraindication[5]
Laboratory
- screening for tuberculosis, hepatitis B, hepatitis C & HIV1 infection (& treatment) prior to initiating biologic immunosuppressive agent[3]
Management
- whenever possible bring patients up to date on vaccinations prior to initiating biologic immunosuppressive agent[3]
More general terms
References
- ↑ 1.0 1.1 Singh JA et al Risk of serious infection in biological treatment of patients with rheumatoid arthritis: a systematic review and meta-analysis. Lancet. May 11, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25975452 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961704-9/abstract
Dixon WG. Rheumatoid arthritis: Biological drugs and risk of infection. Lancet 2015 May 11 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25975453 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961907-3/abstract - ↑ 2.0 2.1 2.2 Kalb RE, Fiorentino DF, Lebwohl MG et al Risk of Serious Infection With Biologic and Systemic Treatment of Psoriasis: Results From the Psoriasis Longitudinal Assessment and Registry (PSOLAR). JAMA Dermatol. 2015 May 13 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25970800
- ↑ 3.0 3.1 3.2 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 19 American College of Physicians, Philadelphia 2012, 2015, 2022
- ↑ 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
- ↑ 5.0 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