Immunosuppressive therapy: Difference between revisions
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== Specific Medications == |
== Specific Medications == |
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! Medications |
! Medications |
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! Target |
! Target |
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| [[Rituximab]] |
| [[Rituximab]] |
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| CD20, on B cells |
| Anti-CD20 antibody, on B cells |
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| Long-term B cell depletion |
| Long-term B cell depletion |
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|[[Ocrelizumab]] |
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|Anti-CD20 antibody |
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| [[Natalizumab]] |
| [[Natalizumab]] |
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| Bruton's tyrosine kinase (BTK), on B cells |
| Bruton's tyrosine kinase (BTK), on B cells |
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| Invasive aspergillosis and other fungal infections |
| Invasive aspergillosis and other fungal infections |
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|Steroids |
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|[[Cyclosphosphamide]] |
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|Antimetabolite |
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|[[Leflunomide]] |
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|Antimetabolite |
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|[[Methotrexate]] |
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|Antimetabolite |
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|[[Azathioprine]] |
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|Antimetabolite |
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|[[6-mercaptopurine]] |
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|Antimetabolite |
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|[[Mycophenolic acid]] |
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|Antimetabolite |
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|[[Mycophenolate mofetil]] |
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|Antimetabolite |
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|[[Tacrolimus]] |
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|Calcineurin inhibitor |
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|[[Cyclosporine]] |
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|Calcineurin inhibitor |
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|[[Sirolimus]] |
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|Calcineurin inhibitor |
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|[[Baricitinib]] |
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|JAK inhibitor |
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|[[Tofacitinib]] |
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|JAK inhibitor |
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|[[Upadacitinib]] |
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|JAK inhibitor |
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|[[Adalimumab]] |
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|Anti-TNF antibody |
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|[[Golimumab]] |
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|Anti-TNF antibody |
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|[[Certolizumab pegol]] |
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|Anti-TNF antibody |
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|[[Etanercept]] |
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|Anti-TNF |
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|[[Infliximab]] |
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|Anti-TNF antibody |
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|[[Sulfasalazine]] |
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|Anti-inflammatory |
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|[[5-aminosalicylic acid]] and [[mesalamine]] |
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|Anti-inflammatory |
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|[[Anakinra]] |
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|IL-1 receptor antagonist |
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|[[Canakinumab]] |
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|IL-1 receptor antagonist |
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|[[Tocilizumab]] |
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|Anti-IL6 |
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|[[Sarilumab]] |
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|Anti-IL6 |
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|[[Ustekinumab]] |
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|Anti-IL12/IL23 |
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|[[Secukinumab]] |
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|Anti-IL17 |
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|[[Ixekizumab]] |
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|Anti-IL17 |
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|[[Brodalumab]] |
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|Anti-IL17 receptor |
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|[[Belimumab]] |
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|Anti-BLyS |
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|[[Guselkumab]] |
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|Anti-IL23 |
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|[[Risankizumab]] |
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|Anti-IL23 |
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|[[Abatacept]] |
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|Selective T-cell costimulation blocker |
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|[[Fingolimod]] |
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|Selective T-cell costimulation blocker |
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|[[Siponimod]] |
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|S1PR agonist |
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|[[Ozanimod]] |
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|S1PR agonist |
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|[[Apremilast]] |
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|Phosphodiesterase inhibitor |
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|[[Vedolizumab]] |
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|Anti-integrin |
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Revision as of 17:03, 2 November 2021
Screening
Before starting immunosuppressive therapy, consider the following investigations:
- Tuberculin skin test
- Strongyloides serology, if from endemic country
- Hep B and C serology
- Cytomegalovirus serology
- HIV serology
Management
- Latent TB infection: start treatment at least 4 weeks prior to starting the biologic
Specific Medications
| Medications | Target | Specific Risks |
|---|---|---|
| Eculizumab | C5 complement | Meningococcus (very high risk), needs MCV4 + MenB + pen prophylaxis |
| Rituximab | Anti-CD20 antibody, on B cells | Long-term B cell depletion |
| Ocrelizumab | Anti-CD20 antibody | |
| Natalizumab | α4-integrin, on all leukocytes except neutrophils | JC virus |
| Ibrutinib | Bruton's tyrosine kinase (BTK), on B cells | Invasive aspergillosis and other fungal infections |
| Steroids | ||
| Cyclosphosphamide | Antimetabolite | |
| Leflunomide | Antimetabolite | |
| Methotrexate | Antimetabolite | |
| Azathioprine | Antimetabolite | |
| 6-mercaptopurine | Antimetabolite | |
| Mycophenolic acid | Antimetabolite | |
| Mycophenolate mofetil | Antimetabolite | |
| Tacrolimus | Calcineurin inhibitor | |
| Cyclosporine | Calcineurin inhibitor | |
| Sirolimus | Calcineurin inhibitor | |
| Baricitinib | JAK inhibitor | |
| Tofacitinib | JAK inhibitor | |
| Upadacitinib | JAK inhibitor | |
| Adalimumab | Anti-TNF antibody | |
| Golimumab | Anti-TNF antibody | |
| Certolizumab pegol | Anti-TNF antibody | |
| Etanercept | Anti-TNF | |
| Infliximab | Anti-TNF antibody | |
| Sulfasalazine | Anti-inflammatory | |
| 5-aminosalicylic acid and mesalamine | Anti-inflammatory | |
| Anakinra | IL-1 receptor antagonist | |
| Canakinumab | IL-1 receptor antagonist | |
| Tocilizumab | Anti-IL6 | |
| Sarilumab | Anti-IL6 | |
| Ustekinumab | Anti-IL12/IL23 | |
| Secukinumab | Anti-IL17 | |
| Ixekizumab | Anti-IL17 | |
| Brodalumab | Anti-IL17 receptor | |
| Belimumab | Anti-BLyS | |
| Guselkumab | Anti-IL23 | |
| Risankizumab | Anti-IL23 | |
| Abatacept | Selective T-cell costimulation blocker | |
| Fingolimod | Selective T-cell costimulation blocker | |
| Siponimod | S1PR agonist | |
| Ozanimod | S1PR agonist | |
| Apremilast | Phosphodiesterase inhibitor | |
| Vedolizumab | Anti-integrin |
