Immunosuppressive therapy: Difference between revisions
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! Specific Risks |
! Specific Risks |
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| − | | Eculizumab |
+ | | [[Eculizumab]] |
| C5 complement |
| C5 complement |
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| Meningococcus (very high risk), needs MCV4 + MenB + pen prophylaxis |
| Meningococcus (very high risk), needs MCV4 + MenB + pen prophylaxis |
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| − | | Rituximab |
+ | | [[Rituximab]] |
| CD20, on B cells |
| CD20, on B cells |
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| Long-term B cell depletion |
| Long-term B cell depletion |
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| − | | Natalizumab |
+ | | [[Natalizumab]] |
| α4-integrin, on all leukocytes except neutrophils |
| α4-integrin, on all leukocytes except neutrophils |
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| JC virus |
| JC virus |
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| − | | Ibrutinib |
+ | | [[Ibrutinib]] |
| 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 |
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| − | | |
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Revision as of 20:50, 14 October 2019
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 | Invasive aspergillosis and other fungal infections |
