Etanercept (Enbrel) A fusion protein containing the human TNF receptor bound to a human IgG1 Fc domain. Acts by binding and inhibiting TNF, the cytokine that contributes to inflammatory and immune responses.Indicated to reduce signs and symptoms of active arthritis in patients with psoriatic arthritis and to help prevent bone erosions. The adult dose is 25 mg subcutaneous (sc) twice weekly .The pediatric dose is 0.4 mg/kg subcutaneous ; maximum single dose 25 mg . Documented hypersensitivity; sepsis; concurrent live vaccination; reactivation of tuberculosis; possible drug-induced lupus. Should be avoided in pregnancy and Caution in impaired renal function and asthma; discontinue administration if a serious infection develops; adverse effects may include pain at injection site, localized erythema, rash, UTI (urinary tract) symptomatology, GI (gastro intestinal tract ) upset, nausea, vomiting, rhinitis, and cough.
Infliximab (Remicade) Neutralizes cytokine TNF-alpha and inhibits its binding to TNF alpha receptor. Mix in 250 mL normal saline for infusion over 2 h. Must use with low protein–binding filter (<1.2 µm). Indicated to reduce signs and symptoms of active arthritis in patients with psoriatic arthritis and to help prevent bone erosions. The adult dose is 5 mg/kg IV infusion at 0, 2, and 6 week as induction regimen; then, 5 mg/kg every 8 weeks (q8wk) for maintenance IV infusion must be administered over at least 2 h; must use infusion set with in-line, sterile, nonpyrogenic, low-protein–binding filter (pore size <1.2 µm) and not established for pediatrics . Documented hypersensitivity may occur .Avoided in pregnancy and TNF-alpha modulates cellular immune responses; anti-TNF therapies, such as infliximab, may adversely affect normal immune responses and allow development of super infections; more cases of lymphoma were observed in TNF-alpha blockers compared with control groups; may increase risk of reactivation of tuberculosis in patients with particular granulomatous infections .
Adalimumab (Humira) Recombinant human IgG1 monoclonal antibody specific for human TNF. Binds specifically to TNF-alpha and blocks interaction with p55 and p75 cell-surface TNF receptors. Indicated for reducing signs and symptoms of active arthritis in psoriatic arthritis. The adult dose is 40 mg subcutaneous every 2 week. May interfere with immune response to live virus vaccine (MMR) and reduce efficacy; MTX decreases clearance (available data do not support adjusting dose of either adalimumab or MTX); coadministration with anakinra (an interleukin 1 antagonist that also blocks TNF) may cause additive adverse effects, particularly development of serious infections . Documented hypersensitivity; active infection. Avoided in pregnancy. Causes immunosuppression; may reactivate tuberculosis infection; increases risk for lymphoma development; associated with CNS demyelination (rare); discontinue if serious infection develops; autoantibody development may occur causing lupus like syndrome; may cause hypersensitivity reactions, including anaphylaxis and adverse hematologic effects (i.e., pancytopenia, a plastic anemia).
Golimumab (Simponi) Tumor necrosis factor (TNF)–alpha inhibitor. Decreases inflammation caused by overproduction of TNF associated with chronic inflammatory diseases. Indicated for moderate-to-severe rheumatoid arthritis, active psoriatic arthritis, and active ankylosing spondylitis. Available as 50-mg/mL, single-dose Simponi SmartJect (Autoinjector) or a prefilled syringe. The adult dose is 50 mg subcutaneous monthly with or without MTX or other non biologic DMARD . Higher incidence of serious infections may occur when coadministered with abatacept, anakinra, or rituximab (do not administer concurrently); may decrease humoral response to live-virus vaccines (eg, MMR). Documented hypersensitivity; active infections. Avoided in pregnancy. Similar to other TNF–alpha inhibitors, may cause reactivation of tuberculosis or hepatitis B; test patients for latent tuberculosis before initiating treatment; serious infections (eg, bacterial sepsis, severe invasive fungal infections, opportunistic infections) may occur; do not initiate if infection exists, and discontinue if serious infection or sepsis develops; lymphoma incidence increased over general population; may exacerbate existing demyelinating disease or cause new onset of demyelinating disease; may worsen heart failure or may cause new onset of heart failure; common adverse effects include upper respiratory tract infection, sore throat, and nasal congestion .
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