Immunosuppressive therapy

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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