TNF inhibitors Flashcards
Infliximab is chimeric (human–mouse)
IgG1
T
Adalimumab and golimumab are chimeric (human - mouse) IgG1
False - they are human recombinant IgG1
Certolizumab pegol is a humanized pegylated Fab fragment
T
List the TNF inhibitors
Ertanecept
Infliximab
Adalimumab
Golimumab
Certolizumab
How do TNF inhibitors work?
Bind to TNF and block its ability to bind to its receptor.
Monoclonal Abs can also activate complement dependant cytotoxicity and induce cellular apoptosis of TNF producing cells
What are the contraindications to TNF inhibitors?
Known hypersensitivity to the medicaiton or its components
- E.G Infliximab is C/I to those allergic to murine proteins
Relative:
- significant active infection
- malignancy
- congestive heart failure
- MS or demylinating diseases
What are the side effects of TNF inhibitors?
Infections:
* Disseminated and/or opportunistic infections: such as histoplasmosis,
coccidioidomycosis, listeriosis, and Pneumocystis jirovecii pneumonia
* symptomatic mycobacterial infections, including reactivation of latent TB
* reactivaiton of hep B
NB these are from studies in RA / IBD - risk is thought to be much lower in monotherapy / derm
Malignancy
* contraversial
* lymphoma
* Keratinocyte cancers
* melanoma
NB: most of this evidence is from patients wiht RA or IBD on multiple immunosupressive agents
Autoimmunity
* increased likelihood of developing anti-nuclear and anti-dsDNA antibodies
* TNF induced SLE
Demyelinating disease
* Exacerbation of disease
Congestive heart failure
Cutaneous reactions
- Psoriasis
- eczematous eruptions
- csvv
- reactive granulomatous dermatitis
- BP
- lichenoid dermatoses
TNF inhibitors do not generally appear to have an adverse effect on viral load or hepatitis activity in psoriasis patients
with chronic hepatitis C virus infection
True
Can you have live vaccinations with TNF inhibitors?
No
Can you use TNF inhibiotrs in pregnancy? and breastfeeding?
Certolizumab does not cross the placenta - likely safe
Others do. ALthough likley safe.
Although transferred to breastmilk, no oral absorption so safe in lactation.
Indications for etanercept?
Psoriasis
- inc with PA
TEN
HS
DM
Cutaneous lupus erythematosus
LP
AI bullous disease
neutrophillic dermatoses
GVHD
relapsing polychondritis
Dosing of ertanacept?
For psoriasis:
50 mg twice weekly for the first 3 months, followed by 50 mg weekly
Subcut injections
What is the dose of infliximab?
For psoriasis:
5 mg/kg administered by slow intravenous infusion at 0, 2, and 6
weeks, and then every 8 weeks.
What are the specific AEs of infliximab?
Infusion reactions.
1 % get anaphylaxis
serum sickness like reaction also reported
Reduced by slower infusino rates
What is the dosage of adalimumab?
psoriasis :
- a loading dose of 80 mg
- followed by 40 mg on day 8
- and then 40 mg every other week.
Hidradenitis suppurativa in adults and
adolescents weighing ≥60 kg
- loading dose of 160 mg,
- 80 mg on day 15,
- and then either 40 mg weekly or 80 mg every other week starting on
day 29.
