RA- Non-TNFi Biologics DI

Question 1

SQ non-TNFi biologics

Answer 1

Abatacept (Orencia)
Sarilumab (Kevzara)
Tocilizumab (Actemra)
Anakinra (Kineret)

Question 2

Orencia MoA

Answer 2

Targets T cells

Question 3

Kevzara MoA

Answer 3

Targets IL-6 inhibitor

Question 4

Actemra MoA

Answer 4

Targets IL-6 inhibitor

Question 5

Kineret MoA

Answer 5

Targets IL-1 inhibitor

Question 6

When are non-TNFi biologics used in RA treatment?

Answer 6

Used as monotherapy or with a non-biologic DMARD

Question 7

Orencia SQ dosing

Answer 7

125mg QW

Question 8

Kevzara SQ dosing

Answer 8

200mg q2w

Question 9

Actemra SQ dosing

Answer 9

<100kg: 162mg SQ QOW, increase to QW as tolerated
≥100kg: 162mg SQ QW

Question 10

Kineret SQ dosing

Answer 10

100mg QD

Question 11

Orencia ADEs

Answer 11

URTI
HA
Nasopharyngitis
Nausea

Question 12

Kevzara ADEs

Answer 12

URTI
UTI
Injection site erythema
Neutropenia
Increased LFTs
Antibody formation

Question 13

Actemra ADEs

Answer 13

URTI
Nasopharyngitis
HA
HTN
Increased LFTs
Increased lipids

Question 14

Kineret ADEs

Answer 14

URTI
Rash
Pyrexia
Influenza-like illness
Gastroenteritis
Vomiting
Antibody formation

Question 15

What should you screen for before starting a non-TNFI biologic?

Answer 15

Latent TB and Hep B infections

Question 16

Orencia monitoring

Answer 16

Monitor CBC at baseline and periodically throughout treatment

Question 17

Kevzara and Actemra monitoring

Answer 17

Monitor ANC, CBC, LFTs, FLP at baseline

Monitor CBC, LFTs, FLP after 4-8 weeks

Monitor CBC and LFTs q3months

Monitor FLP q6months

Question 18

Kineret monitoring

Answer 18

Monitor CBC at baseline and then q3months

Question 19

IV non-TNFi biologics

Answer 19

Abatecept (Orencia)
Rituximab (Rituxan)
Tocilizumab (Actemra)

Question 20

Rituximab MoA

Answer 20

Targets anti-CD20 antibody

Question 21

Orencia IV dosing

Answer 21

Weight-based dosing at 0, 2, and 4 weeks, then q4w

Question 22

Rituximab IV dosing

Answer 22

1g at 0 and 2 weeks (one cycle)

May repeat cycle q16-24wks based on response

Question 23

Actemra dosing

Answer 23

4mg/kg q4w followed by an increase to 8mg/kg q4w based on response

Question 24

IV Orencia ADEs

Answer 24

Same as SQ, but with HTN and infusion reactions too

Question 25

Rituximab ADEs

Answer 25

URTI UTI Nasopharyngitis PML Infusion reactions (premedicate with antihistamine, APAP, corticosteroids)

Question 26

Actemra IV ADEs

Answer 26

Same as SQ, but also infusions site reactions

Question 27

When to use rituximab in RA treatment guidelines

Answer 27

For patients who fail other bDMARDs or with a history of lymphoproliferative disorder

Question 28

Rituximab has to be taken with what drug?

Answer 28

MTX

Question 29

Adequate trial of non-TNFi biologic

Answer 29

6 months