RHEUMATOID ARTHRITIS-MANAGEMENT (BIOLOGIC DMARDs)

SUMMARY

1. Biologics are made with animal, microbial, or human proteins, in contrast to non-biologic DMARDs, which are made from chemicals.

2. Divided into those that inhibit tumor necrosis factor (anti-TNFs) or those that inactivate other factors.

ANTI-TNF
3. Etanercept, infliximab, adalimumab, certolizumab, and golimumab are monoclonal antibodies that bind and inactivate TNF.

4. For RA, these agents are most beneficial when combined with MTX and have been shown to halt and heal erosive damage!

5. assoc. with drug-induced lupus & other SE: injection site/infusion reactions, infections, increased risk for skin cancer, cytopenias, CNS demyelination, and worsening heart failure.

6. Not recommended for patients with NYHA class III/IV heart failure as they may worsen CHF.

AGENTS THAT INHIBIT OTHER FACTORS
7. Rituximab (anti-B-cell antibodies), anakinra (IL1-receptor antagonist), tocilizumab (IL-6 antagonist)

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].