biologics - MABS
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| Infliximab (Remicade) --> MOA and common use | used for UC and Chrohn's. chimeric monoclonal antibody that inhibits TNF. for use in moderate to severe or fistulizing disease. also used as DMARD
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| common toxicities for TNF alpha inhibitors | infusion related, delayed hypersensitivity, inc risk of infection (rule out TB prior to use), HF exacerbations, bone marrow suppression (pancytopenia), hepatitis related to reactivation of latent HBV, vasculitis with CNS involvement
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| Adalimumab (Humira)--> MOA and common use | humanized antibody to TNFalpha so theoretically no senstitivity reactions, moderate-severe CD and UC unresponsive to typical treatments including infliximab. also used as DMARD
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| certolizumab (Cimzia)--> MOA and common use | Pegilated TNF humanized antibody. for moderate to severe CD unresponsive to traditional therapies. also used as DMARD
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| what lab value is significant with certolizumab | CRP levels >10 mg/dL have better remission rates.
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| Golimumab (Simponi) --> MOA and common use | human IgG1k antibody (anti TNF). moderate to severe UC in pts intolerant to other therapies or if need steroid continuous therapy. also used as DMARD
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| ADEs of golimumab | similar to TNFalpha antagonists. infusion related, delayed hypersensitivity, inc risk of infection, HF exacerbations, bone marrow suppression (pancytopenia), hepatitis related to reactivation of latent HBV, vasculitis with CNS involvement
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| Natalizumab (Tysabri) --> MOA and common use | humanized monoclonal antibody to integrin heterodimers and inhibition of alpha 4 integrin mediated leukocyte adhesion. used for moderate to severe active CD in pts with inadequate response to traditional therapies. also used for MS.
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| ADEs of natalizumab | progressive multifocal leukoencephalopathy (REMS-TOUCH program) - watch for mental status changes and obtain LP if needed, hepatotoxicity, inc risk of infection, infusion related reactions
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| RANKL inhibitor - drug and use | denosumab - used to prevent skeletal related events due to bone metastases from solid tumors
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| Biologic DMARDS | infliximab, adalimumab, anakinra, rituximab, abatacept, golimumab, certolizumab pegol, toclizumab, tofacitinib
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| rituximab (Rituxan) --> MOA and common use | CD20 antibody. used in combo with MTX to improve response in rumatoid arthritis
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| anakinra (Kineret) --> MOA and common use | IL2 receptor antagonist. used as DMARD. do not combine with TNF antagonists or increase risk of infections.
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| toclizumab (Actemra) --> MOA and common use | IL6 receptor antagonist. use as second line for pts who fail TNF antagonists. used as DMARD
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| abacept (Orencia) --> MOA and common use | inhibits interaction between antigens and T cells. used in pts who don't respond to TNF antagonists. used as DMARD
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| tofacitinib (Xeljanz) --> MOA and common use | oral Janus kinase inhibitor. typically second line DMARD and can be used as monotherapy or in combination with MTX.
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| etanercept (Enbrel) --> MOA and common use | anti TNF. used if MTX failure. monitor for infection and check baseline PPD.
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