2 - TNF Inhibitors Flashcards
Increased lesion and serum TNF-alpha levels correlate with severity of psoriasis
True
TNF-alpha is a Th1 (T-helper 1 cell) cytokine that stimulates keratinocyte proliferation which then releases additional pro inflammatory cytokines
True
TNF-alpha upregulates intracellular adhesion molecules on the surface of endothelial cells
True
TNF-alpha is chemotactic for neutrophils
True
Decreased liver function (such as in patients with liver disease) does not affect the efficacy of etanercept
True
Etanercept can be used in patients with active hepatitis C infection
True (no adverse effects in these patients)
Etanercept is a fully human dimeric fusion protein RECEPTOR that binds to both soluble and membrane bound TNF-alpha as well as TNF-beta
True
The TNF-alpha inhibitors (Etanercept, Infliximab, Adalimumab) are Pregnancy Category B
True
The TNF-alpha inhibitors (Etanercept, Infliximab, Adalimumab) are relatively contraindicated in patients with family history of demyelinating diseases i.e. Multiple sclerosis
True
The TNF-alpha inhibitors (Etanercept, Infliximab, Adalimumab) is absolutely contraindicated in the setting of active or chronic infections
True
Etanercept affects the mortality of patients with moderate to severe hepatitis
True (small clinical trial showed increased mortality)
The TNF-alpha inhibitors have been associated with reactivation of Hep B fulminant hepatitis and caution and antiviral therapy is advised even without active disease
True
2% of Etanercept patients will develop non-neutralising autoantibodies (not anti-drug antibodies)
True (and so these autoantibodies are not associated with ineffective treatment or adverse events)
The most common adverse event associated with Etanercept is injection site reaction
True (delayed hypersensitivity type reaction)
Anakinra (an IL-1 antagonist) used in conjunction with the TNF-alpha inhibitors (Etanercept, Infliximab, Adalimumab) is associated with an increased risk of serious infections
True
Live-vaccines are absolutely contraindicated in patients on Etanercept (and other biological agents)
True (any vaccine is acceptable EXCEPT live-vaccines)
Etanercept pre filled syringes stored in the refrigerator should be allowed to return to room temperature 15 minutes before injecting in order to reduce injection-related pain
True
Infliximab is a CHIMERIC IgG monoclonal antibody specific to TNF-alpha
True
The neutralising anti-drug antibodies in Infliximab treated patients may reduce efficacy of Infliximab in a minority of patients
True
Infliximab neutralises soluble TNF-alpha and blocks membrane bound TNF-alpha
True
Etanercept prevents TNF-alpha from binding to any cell surface receptors
True
Infliximab should not be given to any patient with a hypersensitivity to murine (mouse) proteins
True (derived from mouse and human sources)
Infliximab >5mg/kg is absolutely contraindicated in patients with congestive cardiac failure
True (absolute contraindication for >5mg/kg - significant mortality and hospitalisation, OK for lower dose)
Infliximab may be prescribed in HIV patients
True (HIV patients with low viral loads and normal CD4 counts have tolerated Infliximab)
20% of Infliximab patients experience infusion reactions
True
Anti-drug antibodies to Infliximab is associated with an increased clearance rate of Infliximab and reduced efficacy
True
Anti-drug antibodies to Infliximab is associated with an increased incidence of infusion reactions
True
Higher antibody titres of anti-drug antibodies to Infliximab corresponds to severity of infusion reactions or serious infectious complications
False
Increasing the dose per kg or shortening the interval between doses combats the formation of anti-drug antibodies to Infliximab
True (other methods include premedicating with oral corticosteroids and concomitant immunomodulatory therapy I.e. Methotrexate)
Infliximab has been associated with hepatotoxicity
True (active liver failure, autoimmune hepatitis, jaundice, cholestasis)
Adalimumab is a fully human IgG recombinant monoclonal antibody to TNF-alpha
True
All 3 TNF-alpha inhibitors (Etanercept, Infliximab, Adalimumab) are metabolised via proteolysis and excreted into the bile and urine
True
The most common adverse event for Adalimumab is injection site reaction
True
The rate of neutralising (anti-drug) antibody production for Adalimumab was 5%, with no correlation with adverse event or disease activity
True
Methotrexate can reduce the clearance of Adalimumab after multiple dosing, but this does not reduce Adalimumab’s efficacy
True
There is an increased risk of active TB infection with the TNF-alpha inhibitors
True (monoclonal antibodies Infliximab and Adalimumab associated with higher rates than Etanercept)
Once TB infection has been treated, TNF-alpha inhibitors can be started
True
Invasive fungal infections are associated with TNF-alpha inhibitors treatment
True
TNF-alpha inhibitors are contraindicated in chronic carriers of Hepatitis B (Hep B surface antigen positive)
True (there is risk of reactivation of Hepatitis B and clinicians are cautioned before using these drugs in patients with history of Hep B)
Patients with congestive cardiac failure should use TNF-alpha inhibitors with caution
True
Positive ANA and anti-dsDNA induction has been associated with the TNF-alpha inhibitors, although the incidence of drug-induced lupus/SLE/lupus-like syndrome remains low
True
TNF-alpha inhibitors may rarely cause haematologic toxicity (leukopenia, neutropenia, thrombocytopenia, pancytopenia)
True
The risk of lymphoma and skin cancer is unclear in patients on TNF-alpha inhibitors
True
Patients with underlying conditions that predispose to infection i.e. Diabetes should be monitored closely whilst on TNF-alpha inhibitors
True (it is reasonable to withdraw therapy in patients with active infections)
