Biological DMARDs

Question 1

What are you worried about in giving any biological DMARD?

Answer 1

Infections! These drugs are immunosuppressors. Dont give them with active infections, and worry about getting infections or reactivating old ones (TB!)

Question 2

What are the TNF-alpha blockers? What is their ADE?

Answer 2

1. Adalimumab
2. Etanercept
3. Infliximab
4. Golimumab
5. Certolizumab pegol
   ADE: Malignancies

Question 3

Adalimumab MOA?

Answer 3

TNF-alpha mAb. Binds TNF-alpha and blocks interaction with p55 and p75

Question 4

Adalimumab ADE?

Answer 4

Lupus like symptoms (arthralgia, myalgia, fatigue, skin rash), CHF

Question 5

Etanercept structure?

Answer 5

TNF-alpha receptor/Ab fusion protein.. p75 bound to IgG1

Question 6

Etanercept ADE

Answer 6

Lupus-like symptoms

Question 7

Infliximab structure/MOA

Answer 7

Chimeric TNF-alpha mAb; binds soluble and transmembrane TNF-alpha

Question 8

Infliximab ADE

Answer 8

CHF, Lupus like symptoms, LFTs

Question 9

Golimumab structure/MOA

Answer 9

Human derived mAb to TNF-alpha, has variable and constant regions; binds soluble and transmembrane TNF-alpha

Question 10

Golimumab ADE

Answer 10

Blood dyscrasia, Lupus like symptoms

Question 11

Certolizumab pegol structure/MOA

Answer 11

Fab fragment of humanized TNF-alpha Ab; binds soluble and transmembrane TNF-alpha

Question 12

Certolizumab pegol ADE

Answer 12

Blood dyscrasia, Lupus-like symptoms

Question 13

Abatacept structure/MOA

Answer 13

CTLA4/IgG1 fusion protein; blocks CD28 from activating T cells

Question 14

Abatacept ADE

Answer 14

Contains maltose which can mess w/ blood glucose test

Question 15

Rituximab structure/MOA

Answer 15

Chimeric CD20/IgG1k mAb. Kills B cells. Sensitization to cytotoxic tx in B-cell lymphoma

Question 16

Rituximab ADE

Answer 16

CHF, Blood dyscrasia, toxic epidermal necrolysis, Steven Johnson, Contraindicated in pregnancy

Question 17

Anakinra structure/MOA

Answer 17

Recombinant IL-1 receptor antagonist –> decreases inflammatory response

Question 18

Anakinra ADE

Answer 18

Blood dyscrasia

Question 19

Tocilizumab structure/MOA

Answer 19

IL-6 receptor antagonist; binds to soluble and membrane bound IL-6 receptors –> decreases immune response regulator production

Question 20

Tocilizumab ADE

Answer 20

Blood dyscrasia, LFTs (get serum lipids too)

Question 21

Which biological DMARDs are administered SC?

Answer 21

Abatacept, Adalimumab, Anakinra, Certolizumab, Etancercpet, Bolimumab

Question 22

Which bio DMARDs are IV?

Answer 22

Abatacept, Infliximab, Rituximab, Tocilizumab