Biologics & targeted DMARD therapeutics
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What monitoring should be done when on Biologics?
• For co-morbidities • Full blood count (FBC) • Renal function (eGFR, Cr) • Liver function tests (LFT’s, esp. AST and ALT and also albumin) • Test for tuberculosis • Hepatitis screen (B and C) • Chest x-ray • Ongoing therapy should be reviewed at least every 6 months
What are you at risk of when taking biologics?
• Increased risk of Infection Considerations required around surgery • Potential increased risk of malignancy • Potential increased risk to patients with cardiac failure (class III or IV) TNF inhibitors
T/F = Alcohol use is not ok with Biologics?
• No problems within normal limits (however may need reduction/cessation due to concomitant DMARDs)
What pharmaceutical care issues are required for Biologics?
• Patients should remain on their specified brand of treatment unless it is converted under the direction of the prescriber • Traceability – essential for pharmacovigilance • Monitoring - specific
What class of drug is Infliximab and what preparations does it come as?
• Indications = RA Preparations (originator drug and biosimilar agents). Powder for infusion (IV) AND Pre-filled pen (SC) • Dosing: Example: RA (with MTX once a week) 3mg.kg at week 0, 2, 6 and then every 8 weeks
What is the treatment time with Infliximab?
IV infusion administration • Over 2 hours and require 1 – 2 hours observations afterwards • Pre-treatment – antihistamine, hydrocortisone and/or paracetamol • The infusion rate may be lowered esp. if previous reactions
What are side-effects of Infliximab?
Very common – infection (upper respiratory infection), headache, infusion related reaction, pain Most serious – serious infections and reactivations, new or worsening HF, delayed hypersensitivity, haematological reactions, demyelinating disorders, hepatobiliary events, malignancies, serious infusion reactions
What are the contraindications of Infliximab?
• Hypersensitivity to other murine proteins • Severe infection, TB, abscesses, opportunistic infections • Moderate to severe heart failure
What are the cautions of Infliximab?
• Chronic/Hx recurrent infection/immunosuppressive drugs • Patients with demyelinating diseases • Malignancy • Mild heart failure • Elderly