|
etanercept
|
Enbrel
|
25 mg given subcutaneously
by injection twice a week
|
Local skin reactions with
some pain, swelling, itching or redness at the injection site
|
There is some concern that
Enbrel has the potential to interfere with the ability to fend off infections
and thus could allow an ongoing infection to worsen and even to enter
the blood stream (this is called sepsis). Thus at the earliest onset of significant infection, it is preferable
for a patient to hold their Enbrel and get in touch with their physician
for proper treatment. Also there
is some concern about receiving vaccinations, particularly live vaccines,
and this should not be given in conjunction with Enbrel
|
| anakinra |
Kineret |
100mg
sub-cutaneously daily by injection
|
Skin
reactions at the injection site is by far the most common problem.These
tend to be mild and often easily remedied with applications of ice or
use of topical creams (check with your rheumatologist for recommendations).
No evidence thus far of significant risk of TB as with the TNF inhibitors
but only time will tell if the same risk will exist.No evidence of any
significantly increased risk of malignancy.
|
Most
doctors would still test with PPD and check a baseline chest x-ray for
any increased risk with this treatment. There may be a higher frequency
of pulmonary problems including pneumonia in those patients with underlying
asthma and pre-existing pulmonary problems. Kineret has been approved
only for use in rheumatoid arthritis patients who have already failed
at least one disease modifying drug. It has not been officially been approved
to be used in combination with the TNF inhibitors, although this idea
is currently being explored in research studies. This biologic agent will
be slightly less expensive than the TNF inhibitors. It certainly will
be considered in patients who have only experienced a partial response
to methotrexate treatment. |
|
infliximab
|
Remicade
|
3 to 10 mg/kg given every
eight weeks by IV infusion in patients already on methotrexate
|
There can be some infusion
reactions with the IV administration including some chills, itching,
hives, rash, decreased blood pressure all of which are usually considered
mild in severity and easily remedied
|
Once again, since Remicade
is also blocking tumor necrosis factor similarly to Enbrel, the risk
of infections and use of live vaccines again are concerns
|
