Immunosuppressive therapy
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Immunosuppressive therapy
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 | CD20, on B cells | Long-term B cell depletion |
| Natalizumab | α4-integrin, on all leukocytes except neutrophils | JC virus |
| Ibrutinib | Bruton's tyrosine kinase (BTK), on B cells |
