RA- TNFI Biologics DI Flashcards
SQ TNFi biologics
Entanercept (Enbrel)
Adalimumab (Humira)
Golimumab (Simponi)
Certolizumab (Cimzia)
TNFi biologic MoA
Target pro-inflammatory cytokines: TNF-alpha, IL-1, IL-6, B and T cells
Enbrel dosing
50mg SQ QW, or 25mg SQ BIW
Humira dosing
40mg SQ Q2W, but do it QW if patient isn’t taking it with MTX
Simponi dosing
50mg SQ qmonth
Cimzia dosing
400mg SQ at 0, 2, and 4 weeks, then 200mg Q2W after
Enbrel ADEs
Pancytopenia
Injection site reactions
Diarrhea
Rash
Humira ADEs
Sinsuitius
URTI
Antibody formation
Injection site reactions
HA
Rash
Simponi ADEs
URTI
Nasopharyngitis
Antibody formation
Injection site reaction
Cimzia ADEs
URTI
UTI
Antibody formation
Dizziness
HTN
Rash
Which SQ TNFi biologic MUST be taken with MTX?
Simponi
Which SQ TNFi biologics can be taken alone OR with MTX?
Enbrel
Humira
Cimzia
TNFi BBW
Malignancies, lymphomas, serious infections leading to hospitalization and death
TNFis can lead to exacerbations of…
MS
SLE
What should you screen for in all patients before starting TNFi biologic treatment?
Latent TB and Hep B
Avoid TNFi biologics in what disease state?
NYHA Class III and IV HF, LVEF <50%
TNFi biologic: all of them should be monitored for this
CBC at baseline and periodically throughout treatment
IV TNFi biologics
Infliximab (Remicade)
Golimumab (Simponi Aria)
Remicade dosing
3mg/kg over ≥2 hours at 0, 2, and 6 weeks; then 3-10mg/kg q4-8w
Simponi Aria dosing
2mg/kg over 30 minutes at weeks 0 and 4; then 2mg/kg q8w
Remicade ADEs
URTI
Infusion-related reactions (premedicate with antihistamines, APAP, corticosteroids)
HA
Abdominal pain
Antibody formation
Simponi Aria ADEs
URTI
ALT/AST elevation
HTN
Rash
Neutropenia
Antibody formation
Which IV TNFi biologic HAS to be taken with MTX?
Remicade
Do you have to take Simponi Aria with MTX?
No, but it’s preferred
Remicade monitoring
Monitor CBC and LFTs at baseline, LFTs again after 4-8 weeks
Adequate trial length of TNFI biologics
3 months
