Dosing Schedules Flashcards
Methotrexate
First year, FBC U&E LFT every 2 weeks until stable dose and for 8w if bloods stable then monthly.
After first year reduce 2 monthly
Adalimumab - What is name of biosimilar? (4)
What is dose?
What is target cytokine?
Idacio 40mg fortnightly injections
Amgevita
Hyrimoz
Humira
Anti TNF
Initial monitoring requirements:
RA 6 months to assess improvement
AS 3 months
For RA, crohns and HS can have 80mg fortnightly or 40mg weekly
All Anti TNFs may cause a flare of uveitis but if recurrent a switch of Anti TNF may be warranted
Secukinumab
What is target cytokine?
What is dose?
Loading dose is 150mg once weekly for 5 weeks then every month
Can have 300mg monthly if Ank Sond
Cosentyx
Caution with IBD
IL17 inhibitor
Review at 16w
Etanercept
What is biosimilar?
What is dose?
What is target cytokine?
Benepali
50mg once weekly
Anti- TNF
Don’t use in IBD patients
Less effective for uveitis
Certolizumab Pegol
Brand name?
Dose?
Target cytokine?
Cimzia
400mg loading dose fortnightly for 3 doses
Then 200mg 2 weekly or 400mg 4 weekly
Sustained remission after a year consider 200mg 3 weekly then monthly
Anti TNF
Tocilizumab
Dose?
Target cytokine?
Caution?
RoActemra
Once weekly injection 162mg
(or once monthly infusion)
Caution re liver injury (rare but serious), symptoms: tiredness, abdo pain and jaundice
Can increase cholesterol levels, need blood test every 4 weeks - lipid profile, LFTs probably for first 6 months then every 12w after
Caution - won’t raise CRP GP should be aware if monitoring for infection
Interleukin 6 inhibitor
Abatercept
SC injection
125mg once weekly
Orencia
Review response within 6 months
T cell activation inhibitor
(or infusion)
Upadacitinib
Rinvoq
JAK inhibitor
15mg oral tablet once day
Benefit starts 2-8 weeks after taking tablet, full benefit after 3-6 months
Usually prescribed alongside MTX but not essential
No other immunosuppressants
Take the tablet with or after food
No grapefruit as it increases risk of side effects
Increases risk of VTE warn pts re signs and symptoms. Urgently attend if suspected.
Recommended avoid in pts >65 and in smokers or with other CV or malignancy risk factors unless No suitable alternatives
Monitor usual bloods at 6w and LIPIDS at 12w
Rituximab
Truxima
Lowers B cells
Improvement seen at 8-16 weeks post treatment
Intravenous infusion in hospital over 6 hours for first dose. Then usually repeat 2 weeks later.
Before treatment, given meds prior to help prevent allergies: Should have paracetamol at home and chlorphenamine and take prior to coming to hospital.
Pt must phone team on day of infusion to confirm feels well and will be attending. (Or to rebook if not well)
Should not take any blood pressure tablets on day of infusion but pt SHOULD bring with them to hospital.
Will have further rituximab doses when symptoms return eg 6m to a year.
Bloods taken at 8 weeks to check FBC
then every 3-6 months
Stop 3-6 months before elective surgery
Ixekizumab
Taltz
IL17
160mg loading dose then 80mg every 4 weeks
Baricitinib
Olumiant
JAK inhibitor
4mg daily
?lower dose >75 years old (2mg)
Blood tests regularly
Lipid profile 12w after treatment initiated and treat hyperlipidaemia. Monitor LFTs and FBC 6w post treatment
Apremilast
Otezla
PDE4 inhibitor
For psoriatic arthritis
Dose: see BNF for titration schedule
Then 30mg tablets BD (12 hours apart)
Risk of suicidal thoughts
Caution with low body weight
Takes 4m to work
Bimekizumab
Bimzelx
IL17F
For psoriatic arthritis and AS Inc nrAxSpa
160mg sc injection 4w
IBD contraindicates use
Golimumab
Simponi
Anti tnf
50mg monthly on same date each month
If pt >100kg can increase dose to 100mg
Ustekinumab (Stelara)
Check weight
SC injection 45mg then 45mg at 4 weeks then 45mg every 12w
Check response at 28w
If pt weight >101kg consider 90mg dose
IL12 and IL23
For PsA or PsO or IBD only not AS
Observe for signs of exfoliative dermatitis - increased redness and shedding of skin over a large area of body
Store in fridge
