II. Indications: Autoimmune Conditions
- FDA Approved
- Rheumatoid Arthriitis
- Juvenile polyarticular Rheumatoid Arthritis
- Spondyloarthropathy (e.g. Ankylosing Spondylitis)
- Inflammatory Bowel Disease (Crohns Disease, Ulcerative Colitis)
- Psoriasis
- Psoriatic Arthritis
- Off-Label
- Sarcoidosis
- Hidradenitis suppuritiva
- Adamantiades-Behcet's Disease
- Pyoderma Gangrenosum
- Dermatomyositis
- Scleroderma
- Noninfectious Uveitis
III. Preparations
- Older xTNF agents included Thalidomide
- Modern xTNF agents (in 2016) are primarily monoclonal antibodies
- Examples include Infliximab (Remicade), Adalimumab (Humira) and Etanercept (Enbrel)
IV. Complications
- Nonmelanoma Skin Cancer
- Congestive Heart Failure (Infliximab)
- Multiple Sclerosis
- Opportunistic Infection or reactivated infections
- Tuberculosis
- Screen for latent infection prior to initiating TNF agent
- Disseminated Histoplasmosis
- Coccidioidomycosis
- Blastomycosis
- Hepatitis B
- Cytomegalovirus
- Leishmaniasis
- Tuberculosis
- References
V. Prevention
- Update Vaccinations prior to starting therapy (Live Vaccines may not be used with xTNF agents)
- Screen for Tuberculosis and other infections prior to starting xTNF-a agents
- Requires regular lab monitoring depending on agent and condition being treated
- Skin Cancer Prevention with regular use of Sunscreen and Self Skin Exam
- Patients should seek medical evaluation for acute infectious symptoms while on xTNF agents
VI. References
- (2018) Presc Lett 25(7): 40