bDMARDS and tsDMARDS Flashcards
What is the Targeted Synthetic DMARD?
Tofacitinib
What is the tsDMARD?
Tofacitinib
What are the 7 Biologic DMARDS?
Etanercept Adalimumab Infliximab Rituximab Abatacept Tocilizumab Anakinra
What are 3 TNF alpha Antagonists?
Etanercept
Adalimumab
Infliximab
What is a B cell depleter mAb?
Rituximab
What drug (-) T cell activation?
Abatacept
What is an IL-6 Receptor mAb?
Tocilizumab
What is an IL-1 Antagonist?
Anakinra
bDMARDS should NEVER be combined with?
Each other!
Generally what is good and bad about bDMARDS?
Faster and stronger response
More expensive and risk of more severe adverse effects
What are the adverse effects of TNF alpha Antagonists (2)?
Severe allergic reactions
Serious infections like TB
What TNF alpha Antagonist involves 2 p75 TNF receptors bound to Fc portion of IgG?
Etanercept
How is Etanercept given?
1x/week via SubQ
What TNF alpha Antagonist is a chimeric mAb?
Infliximab
How is Infliximab given?
1x/ every 8 weeks via IV
What TNF alpha Antagonist is a human mAb?
Adalimumab
How is Adalimumab given?
1x/ every 2 weeks via SubQ
Which TNF alpha Antagonist has a lower risk of anti-drug antibody formation?
Adalimumab
What is the MOA for Rituximab?
Antibody that targets CD20 on pre-B cell surface so that CD20 is lost as B cells differentiate into plasma cells
If what things are present, will there be a greater likelihood of response to Rituximab?
Rheumatoid factor
Anti-cyclic Citrullinated Peptide antibodies
What is a possible adverse effect with Rituximab?
Infusion hypersensitivity reactions
What is the MOA for Abatacept?
Prevents CD28 from binding to CD80/CD86
= (-) T cell activation
What is the possible adverse effect of Abatacept?
Serious infections
Tocilizumab is an Anti-IL-6 Receptor Antibody. What forms does it target?
Membrane bound and soluble IL-6 receptors
What is the effective result of Tocilizumab targeting IL-6 Receptors?
Limits hepatic acute phase response and activation of T/B cells, macrophages and osteoclasts
What are 2 possible adverse effects of Tocilizumab?
Upper respiratory tract infections
Life threatening infections
Anakinra is an IL-1 Antagonist. How often is it used?
Rarely used - less efficacious
What are 2 possible adverse effects of Anakinra?
Serious infections
Hypersensitivity reactions
How do tsDMARDs differ from bDMARDS?
Small molecules, NOT proteins
How is Tofacitinib given that is generally different from most DMARDS?
ORALLY
What is the MOA for Tofacitinib and the effect it causes?
JAK3 Antagonist
==> (-) production of IL-17, IFNgamma and CD4 T cells
What are the adverse effects associated with Tofacitinib?
Serious infections with opportunistic pathogens
Increased malignancies
Cardiovascular warnings
What are the adverse effects associated with Tofacitinib?
Serious infections with opportunistic pathogens
Increased malignancies
Cardiovascular warnings
Once Methotrexate has been tried, what bDMARD should be added?
TNF alpha Antagonists
Tofacitinib can be used with or without Methotrexate. It is a first choice after what?
csDMARDS
Once Methotrexate + TNF alpha Antagonists have been tried and they were not successful, what should then be tried?
Methotrexate + NON-TNF bDMARD or tsDMARD
