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P3 - immunosuppression

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nelso418's version from 2017-12-11 02:27

Psoriasis

Question Answer
Certolizumab (Cimzia)Psoriatic Arthritis Only
Golimumab (Simponi)Psoriatic Arthritis Only
Calcineurin Inhibitors (topical)Tacrolimus, pimercrolimus - desirable for thin-skinned areas
Vitamin D analogCalcipotriene
Vitamin A analogTazarotene - teratogenic
Oral Calcineurin inhibscyclosporine and tacrolimus - used for exacerbations only - CYP3A4
Apremilast (Otezla)new oral systemic agent for plaque psoriasis and psoriatic arthritis - ADRS: GI, HA, weight loss, depression/suicidal thoughts
Traditional Systemic CorticosteroidsAVOID in psoriasis d/t increased risk of exacerbation
Biologics in psoriasisUsually used as MONOTHERAPY (no MTX)
Ustekinumab (Stelara)IL-12 and IL-23 - well tolerated, efficacy inversely related to weight
Secukinumab (Cosentyx)IL-17 - ONLY for plaque psoriasis, latex allergy
Ixekizumab (Taltz)IL-17 - ONLY for plaque psoriasis, may worsen IBS, Chron's, UC
Brodalumab (Siliq)IL-17 - ONLY for plaque psoriasis, REMS suicidal behavior
Guselkumab (Tremfya)IL-23 - ONLY for plaque psoriasis
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Biologics

Question Answer
Adalimumab (Humira®)TNF alpha blocker - Avoid in heart failure (HF)
Certolizumab pegol (Cimzia®)TNF alpha blocker PsA only Avoid in HF
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Etanercept (Enbrel) : TNF alpha blocker Avoid in HF
Question Answer
Golimumab (Simponi®, Simponia Aria®)TNF alpha blocker PsA only Avoid in HF
Infliximab (Remicade®)TNF alpha blocker HA, ALT increase Avoid in HF
Abatacept (Orencia®)Cytotoxic T-cell agent (CD 80 and 86) - PsA only, RA - Worsening of COPD/pulmonary function
Apremilast (Otezla®)PDE4 Inhibitor - PP/PsA - GI upset, HA, weight loss suicidal thoughts
Rituximab (Rituxan®)B cell CD20 receptor inhibitor to induce apoptosis, RA only
Sarilumab (Kevzara®)IL-6 receptor blocker - GI perforation - Avoid initiation if ANC <2000, plts <150, or ALT or AST >1.5x ULN. Stop if ALT or AST >5x ULN.
Tocilizumab Actemra®)IL-6 receptor blocker - GI perforation - Avoid initiation if ANC <2000, plts <150, or ALT or AST >1.5x ULN. Stop if ALT or AST >5x ULN.
Tofacitinib citrate (Xeljanz®)Janus-Associated Kinase (JAK) inhibitor
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Question Answer
Ustekinumab (Stelara)IL-12 and IL-23 - well tolerated, efficacy inversely related to weight IV only for Chron's
Secukinumab (Cosentyx)IL-17 - latex allergy
Ixekizumab (Taltz)IL-17 - ONLY for plaque psoriasis, may worsen IBS, Chron's, UC
Brodalumab (Siliq)IL-17 - ONLY for plaque psoriasis, REMS suicidal behavior
Guselkumab (Tremfya)IL-23 - ONLY for plaque psoriasis
memorize