RA- Non-TNFi Biologics DI Flashcards
SQ non-TNFi biologics
Abatacept (Orencia)
Sarilumab (Kevzara)
Tocilizumab (Actemra)
Anakinra (Kineret)
Orencia MoA
Targets T cells
Kevzara MoA
Targets IL-6 inhibitor
Actemra MoA
Targets IL-6 inhibitor
Kineret MoA
Targets IL-1 inhibitor
When are non-TNFi biologics used in RA treatment?
Used as monotherapy or with a non-biologic DMARD
Orencia SQ dosing
125mg QW
Kevzara SQ dosing
200mg q2w
Actemra SQ dosing
<100kg: 162mg SQ QOW, increase to QW as tolerated
≥100kg: 162mg SQ QW
Kineret SQ dosing
100mg QD
Orencia ADEs
URTI
HA
Nasopharyngitis
Nausea
Kevzara ADEs
URTI
UTI
Injection site erythema
Neutropenia
Increased LFTs
Antibody formation
Actemra ADEs
URTI
Nasopharyngitis
HA
HTN
Increased LFTs
Increased lipids
Kineret ADEs
URTI
Rash
Pyrexia
Influenza-like illness
Gastroenteritis
Vomiting
Antibody formation
What should you screen for before starting a non-TNFI biologic?
Latent TB and Hep B infections
Orencia monitoring
Monitor CBC at baseline and periodically throughout treatment
Kevzara and Actemra monitoring
Monitor ANC, CBC, LFTs, FLP at baseline
Monitor CBC, LFTs, FLP after 4-8 weeks
Monitor CBC and LFTs q3months
Monitor FLP q6months
Kineret monitoring
Monitor CBC at baseline and then q3months
IV non-TNFi biologics
Abatecept (Orencia)
Rituximab (Rituxan)
Tocilizumab (Actemra)
Rituximab MoA
Targets anti-CD20 antibody
Orencia IV dosing
Weight-based dosing at 0, 2, and 4 weeks, then q4w
Rituximab IV dosing
1g at 0 and 2 weeks (one cycle)
May repeat cycle q16-24wks based on response
Actemra dosing
4mg/kg q4w followed by an increase to 8mg/kg q4w based on response
IV Orencia ADEs
Same as SQ, but with HTN and infusion reactions too
Rituximab ADEs
URTI
UTI
Nasopharyngitis
PML
Infusion reactions (premedicate with antihistamine, APAP, corticosteroids)
Actemra IV ADEs
Same as SQ, but also infusions site reactions
When to use rituximab in RA treatment guidelines
For patients who fail other bDMARDs or with a history of lymphoproliferative disorder
Rituximab has to be taken with what drug?
MTX
Adequate trial of non-TNFi biologic
6 months