RA- TNFI Biologics DI

Question 1

SQ TNFi biologics

Answer 1

Entanercept (Enbrel)
Adalimumab (Humira)
Golimumab (Simponi)
Certolizumab (Cimzia)

Question 2

TNFi biologic MoA

Answer 2

Target pro-inflammatory cytokines: TNF-alpha, IL-1, IL-6, B and T cells

Question 3

Enbrel dosing

Answer 3

50mg SQ QW, or 25mg SQ BIW

Question 4

Humira dosing

Answer 4

40mg SQ Q2W, but do it QW if patient isn’t taking it with MTX

Question 5

Simponi dosing

Answer 5

50mg SQ qmonth

Question 6

Cimzia dosing

Answer 6

400mg SQ at 0, 2, and 4 weeks, then 200mg Q2W after

Question 7

Enbrel ADEs

Answer 7

Pancytopenia
Injection site reactions
Diarrhea
Rash

Question 8

Humira ADEs

Answer 8

Sinsuitius
URTI
Antibody formation
Injection site reactions
HA
Rash

Question 9

Simponi ADEs

Answer 9

URTI
Nasopharyngitis
Antibody formation
Injection site reaction

Question 10

Cimzia ADEs

Answer 10

URTI
UTI
Antibody formation
Dizziness
HTN
Rash

Question 11

Which SQ TNFi biologic MUST be taken with MTX?

Answer 11

Simponi

Question 12

Which SQ TNFi biologics can be taken alone OR with MTX?

Answer 12

Enbrel
Humira
Cimzia

Question 13

TNFi BBW

Answer 13

Malignancies, lymphomas, serious infections leading to hospitalization and death

Question 14

TNFis can lead to exacerbations of…

Answer 14

MS
SLE

Question 15

What should you screen for in all patients before starting TNFi biologic treatment?

Answer 15

Latent TB and Hep B

Question 16

Avoid TNFi biologics in what disease state?

Answer 16

NYHA Class III and IV HF, LVEF <50%

Question 17

TNFi biologic: all of them should be monitored for this

Answer 17

CBC at baseline and periodically throughout treatment

Question 18

IV TNFi biologics

Answer 18

Infliximab (Remicade)
Golimumab (Simponi Aria)

Question 19

Remicade dosing

Answer 19

3mg/kg over ≥2 hours at 0, 2, and 6 weeks; then 3-10mg/kg q4-8w

Question 20

Simponi Aria dosing

Answer 20

2mg/kg over 30 minutes at weeks 0 and 4; then 2mg/kg q8w

Question 21

Remicade ADEs

Answer 21

URTI
Infusion-related reactions (premedicate with antihistamines, APAP, corticosteroids)
HA
Abdominal pain
Antibody formation

Question 22

Simponi Aria ADEs

Answer 22

URTI
ALT/AST elevation
HTN
Rash
Neutropenia
Antibody formation

Question 23

Which IV TNFi biologic HAS to be taken with MTX?

Answer 23

Remicade

Question 24

Do you have to take Simponi Aria with MTX?

Answer 24

No, but it’s preferred

Question 25

Remicade monitoring

Answer 25

Monitor CBC and LFTs at baseline, LFTs again after 4-8 weeks

Question 26

Adequate trial length of TNFI biologics

Answer 26

3 months