Immunosuppressants - Anti-CD20 monoclonal antibody

Question 1

Biological DMARDs can be used to treat patients in rheumatology. When should biological DMARDs be used?

1 - failure to achieve remission or low disease severity in 3-6 months followingmethotrexateor other conventional DMARD therapy with max, non-toxic range
2 - chronic use of glucocorticoid alongside a DMARD with a dose of 5mg/day ofprednisoneor equivalent to achieve or maintain remission
3 - multiple courses of treatment with glucocorticoids
4 - continued progression of erosive disease or structural damage that is not accounted for by prior joint damage
5 - all of the above

Answer 1

5 - all of the above

It can be any of these and does not need to be all of them

Question 2

What does mab relate to at the end of a drug name?

1 - indicates a chimeric mAb
2 -indicates a monoclonal antibody
3 - indicates a humanized
4 - indicates a fully human mAb

Answer 2

2 -indicates a monoclonal antibody

B cells are immortalised and selected to create clones capable of producing homogenous antibodies against specific epitopes of target proteins

They are adapted to ensure they are not immunogenic in humans

Question 3

What does ximab relate to at the end of a drug name?

1 - indicates a chimeric mAb
2 -indicates a monoclonal antibody
3 - indicates a humanized mAb
4 - indicates a fully human mAb

Answer 3

1 - indicates a chimeric mAb

Question 4

What does zumab relate to at the end of a drug name?

1 - indicates a chimeric mAb
2 -indicates a monoclonal antibody
3 - indicates a fully human mAb
4 - indicates a humanized

Answer 4

4 - indicates a humanized mAb

Question 5

What does umab relate to at the end of a drug name?

1 - indicates a chimeric mAb
2 -indicates a monoclonal antibody
3 - indicates a fully human mAb
4 - indicates a humanized mAb

Answer 5

3 - indicates a fully human mAb

Question 6

Which of the following are the core CD20 inhibitors we need to be aware of?

1 - Infliximab
2 - Mesalazine
3 - Adalimumab
4 - Rituximab

Answer 6

4 - Rituximab

These drugs suppress excessive immune response through targeting specific aspects of the immune system

Question 7

What is one core adverse event that are caused by ALL monoclonal antibodies?

1 - seizures
2 - immediate/delayed hypersensitivity
3 - leukopenia
4 - hearing loss

Answer 7

2 - immediate/delayed hypersensitivity

Includes urticaria, fever, systemic symptoms and even anaphylaxis

Drugs are typically monitored for 1h after administration and monitored after this

Question 8

What is the mechanism of action of Rituximab?

1 - inhibits transcription of CD20 proteins
2 - inhibits synthesis of B cells
3 - binds and inhibits CD20 on B cells
4 - all of the above

Answer 8

3 - binds and inhibits CD20 on B cells

Activates cell death of B cells through:

• attack complex (complement pathway)
• induces apoptosis
• antibody dependent cell mediated toxicity

Question 9

Monoclonal antibodies are effective by targeting and suppressing aspects of the immune system. What can this increase the risk of?

1 - seizures
2 - autoimmune development
3 - leukopenia
4 - infection

Answer 9

4 - infection

Immune system is reduced so dangerous infections are more likely as well

Important to ensure latent and active infection is treated before commencing Monoclonal antibodies

Question 10

Typically are monoclonal antibody medications such as Rituximab have an impact on the immune system and are large stable molecules. Are these typically given on a weekly or daily basis?

Answer 10

• weekly for treating RA
• Adalimumab = SC 40 mg every 2 weeks
• Infliximab = intravenous infusion 3 mg/kg, then 3 mg/kg, to be taken at week 2 and 6 after initial dose

Question 11

Can Rituximab be prescribed by anyone?

Answer 11

• no

Only prescribed by specialists

Question 12

Which of the following is NOT an indication for the use of Rituximab according to the BNF?

1 - RA
2 - Urticaria
3 - Granulomatosis with polyangiitis and microscopic polyangiitis
4 - Non and-Hodgkin’s lymphoma
5 - Pemphigus vulgaris

Answer 12

2 - Urticaria