Indications

• Crohn’s Disease (see Crohn’s Disease, [[Crohns Disease]])
• Psoriatic Arthritis (see Psoriatic Arthritis, [[Psoriatic Arthritis]])
• Rheumatoid Arthritis (RA) (see Rheumatoid Arthritis, [[Rheumatoid Arthritis]])
• Ulcerative Colitis (UC) (see Ulcerative Colitis, [[Ulcerative Colitis]])

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Pharmacology

• PEGylated Fab Fragment of a Humanized TNF-α Inhibitor Monoclonal Antibody (see Anti-Tumor Necrosis Factor-α Therapy, [[Anti-Tumor Necrosis Factor-α Therapy]])

Metabolism

• xxx

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Administration

• SQ

Dose Adjustment

• Hepatic: xxx
• Renal: xxx

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Adverse Effects

Infectious Adverse Effects of Anti-Tumor Necrosis Factor-α (Anti-TNFα) Therapy

• Aspergillus
  • Invasive Pulmonary Aspergillosis (see Invasive Pulmonary Aspergillosis, [[Invasive Pulmonary Aspergillosis]])
• Blastomyces (see Blastomycosis, [[Blastomycosis]]): case report of 3 cases
• Candida (see Candida, [[Candida]])
  • Candida Esophagitis
  • Candidemia
  • Oropharyngeal Thrush
• Coccidioides Immitis (see Coccidioidomycosis, [[Coccidioidomycosis]])
• Cryptococcus (see Cryptococcosis, [[Cryptococcosis]]): 28 published cases
• Histoplasma (see Histoplasmosis, [[Histoplasmosis]])
• Legionella (see Legionellosis, [[Legionellosis]]): case series of 10 patients
• Listeriosis (see Listeriosis, [[Listeriosis]]): case series of 15 patients
• Mycobacterium Tuberculosis (see Tuberculosis, [[Tuberculosis]])
• Pneumocystis Jirovecii (see Pneumocystis Jirovecii, [[Pneumocystis Jirovecii]])
• Strongyloides (see Strongyloidiasis, [[Strongyloidiasis]]): 1 case report
• Viral Upper Respiratory Infections (however, there is no increased risk of viral pneumonias)

Non-Infectious Adverse Effects of Anti-Tumor Necrosis Factor-α (Anti-TNFα) Therapy

Dermatologic Adverse Effects

• Erythema Multiforme (see Erythema Multiforme, [[Erythema Multiforme]])

Pulmonary Adverse Effects

• Acute Respiratory Distress Syndrome (ARDS) (see Acute Respiratory Distress Syndrome, [[Acute Respiratory Distress Syndrome]])
  • Infliximab
• Granulomatous Lung Disease (see Granulomatous Lung Disease, [[Granulomatous Lung Disease]])
  • Etanercept: can cause a pneumonitis with non-necrotizing granulomas and lymphohistiocytic infiltrates
  • Infliximab: can cause a pulmonary “bronchiocentric allergic granulomatosis” (observed in a patient with ankylosing spondylitis)
• Interstitial Lung Disease (ILD) (see Interstitial Lung Disease, [[Interstitial Lung Disease]])
  • Etanercept/Infliximab: may worsen pre-existing RA-associated interstitial lung disease
  • Infliximab: addition of infliximab can precipitate methotrexate pneumonitis (see Methotrexate, [[Methotrexate]])
  • Adalimumab: interstitial lung disease has been reported
• Pulmonary Infiltrates with Eosinophilia (see Drug-Induced Pulmonary Eosinophilia, [[Drug-Induced Pulmonary Eosinophilia]])
  • Infliximab

Renal Adverse Effetcs

Acute Interstitial Nephritis (see Acute Interstitial Nephritis, [[Acute Interstitial Nephritis]])

• Epidemiology: associated with etanercept

Rheumatologic Adverse Effects

• Accelerated Progression of Rheumatoid Lung Nodules (see Rheumatoid Arthritis, [[Rheumatoid Arthritis]])
  • Etanercept: may accelerate progression of rheumatoid lung nodules
• Drug-Induced SLE (see Systemic Lupus Erythematosus, [[Systemic Lupus Erythematosus]])
  • Adalimumab
  • Etanercept
  • Infliximab

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References

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