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drug adverse effects of biologic immunosuppressive agents

Adverse effects: - increased risk for serious infection compared with traditional DMARDs - 0.6% for standard-dose biological therapy - 1.7% for high-dose biological therapy - 5.5% for combination biological therapy [1] - hold biologic immunosuppressive agent during antibiotic therapy - increased risk for serious infections with adalimumab & infliximab compared with nonmethotrexate other DMARDs [2] - no increased risk for serious infections with ustekinumab or etanercept [2] - risk of cancer similar for DMARDs vs biologic agents in patients with rheumatoid arthritis [4] * breast feeding apparently not a contraindication [5] Laboratory: - screening for tuberculosis, hepatitis B, hepatitis C & HIV1 infection (& treatment) prior to initiating biologic immunosuppressive agent [3] Management: - whenever possible bring patients up to date on vaccinations prior to initiating biologic immunosuppressive agent [3]

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DRUGS: biologic immunosuppressive agent FORM: drug adverse effects biologic immunosuppressive agent

References

  1. Singh JA et al Risk of serious infection in biological treatment of patients with rheumatoid arthritis: a systematic review and meta-analysis. Lancet. May 11, 2015 PMID: 25975452 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961704-9/abstract - Dixon WG. Rheumatoid arthritis: Biological drugs and risk of infection. Lancet 2015 May 11 PMID: 25975453 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961907-3/abstract
  2. Kalb RE, Fiorentino DF, Lebwohl MG et al Risk of Serious Infection With Biologic and Systemic Treatment of Psoriasis: Results From the Psoriasis Longitudinal Assessment and Registry (PSOLAR). JAMA Dermatol. 2015 May 13 PMID: 25970800
  3. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 19 American College of Physicians, Philadelphia 2012, 2015, 2022
  4. Wadstrom H, Frisell T, Askling J et al. Malignant neoplasms in patients with rheumatoid arthritis treated with tumor necrosis factor inhibitors, tocilizumab, abatacept, or rituximab in clinical practice: A nationwide cohort study from Sweden. JAMA Intern Med 2017 Sep 18 PMID: 28975211
  5. Matro R, Martin CF, Wolf D et al. Exposure concentrations of infants breastfed by women receiving biologic therapies for inflammatory bowel diseases and effects of breastfeeding on infections and development. Gastroenterology 2018 May 29 PMID: 29857090