Biologics & targeted DMARD therapeutics

Question 1

What monitoring should be done when on Biologics?

Answer 1

• For co-morbidities
• Full blood count (FBC)
• Renal function (eGFR, Cr)
• Liver function tests (LFT’s, esp. AST and ALT and also albumin)
• Test for tuberculosis
• Hepatitis screen (B and C)
• Chest x-ray
• Ongoing therapy should be reviewed at least every 6 months

Question 2

What are you at risk of when taking biologics?

Answer 2

• Increased risk of Infection
  Considerations required around surgery
• Potential increased risk of malignancy
• Potential increased risk to patients with cardiac failure (class III or IV)
  TNF inhibitors

Question 3

T/F = Alcohol use is not ok with Biologics?

Answer 3

• No problems within normal limits (however may need reduction/cessation due to
  concomitant DMARDs)

Question 4

What pharmaceutical care issues are required for Biologics?

Answer 4

• Patients should remain on their specified brand of treatment unless it is converted under the direction of the prescriber
• Traceability – essential for pharmacovigilance
• Monitoring - specific

Question 5

What class of drug is Infliximab and what preparations does it come as?

Answer 5

• Indications = RA

Preparations (originator drug and biosimilar agents). Powder for infusion (IV) AND Pre-filled pen (SC)

• Dosing: Example: RA (with MTX once a week) 3mg.kg at week 0, 2, 6 and then every 8 weeks

Question 6

What is the treatment time with Infliximab?

Answer 6

IV infusion administration

• Over 2 hours and require 1 – 2 hours observations afterwards
  
  • Pre-treatment – antihistamine, hydrocortisone and/or paracetamol
  • The infusion rate may be lowered esp. if previous reactions

Question 7

What are side-effects of Infliximab?

Answer 7

Very common – infection (upper respiratory infection), headache, infusion
related reaction, pain

Most serious – serious infections and reactivations, new or worsening HF,
delayed hypersensitivity, haematological reactions, demyelinating
disorders, hepatobiliary events, malignancies, serious infusion reactions

Question 8

What are the contraindications of Infliximab?

Answer 8

• Hypersensitivity to other murine proteins
• Severe infection, TB, abscesses, opportunistic infections
• Moderate to severe heart failure

Question 9

What are the cautions of Infliximab?

Answer 9

• Chronic/Hx recurrent infection/immunosuppressive drugs
• Patients with demyelinating diseases
• Malignancy
• Mild heart failure
• Elderly