INFO - Onset of action and dosage for RA DMARDs / biologics

[Guest guest]

American College of Physicians

ACPMedicine.com

S Firestein, MD

Nov 2010

" Rheumatoid Arthritis "

Excerpt from the " Best Therapy " section:

Methotrexate (response rate > 70%; onset of action 6–8 wk; toxicities:

liver [fibrosis, elevated enzymes], teratogen, hematologic, oral

ulcers, alopecia; relative efficacy +++)

Dose: begin at 7.5–10 mg once weekly, then increase to 25 mg/wk over

2–3 mo if necessary; if no response, increase up to 50 mg/wk orally

Leflunomide (response rate 50%; onset of action 2–3 mo; toxicities:

gastrointestinal, liver, skin rash, reversible hair loss, infection,

immunosuppression; teratogen)

Dose: 10–20 mg/day

Hydroxychloroquine (response rate 30–50%; onset of action 2–6 mo;

toxicities: retinopathy, myopathy, hyperpigmentation)

Dose: 200 mg b.i.d.

Sulfasalazine (response rate > 30%; onset of action 2–3 mo;

toxicities: dyspepsia, hemolysis in glucose-6-phosphate dehydrogenase

deficiency)

Dose: 1 g b.i.d. or t.i.d.

Prednisone (response rate > 90%; onset of action < 1 wk; toxicities:

skin atrophy, cataracts, osteoporosis, avascular necrosis, infections,

immunosuppression)

Dose: 5–10 mg/day

Anticytokines

TNF inhibitors

Etanercept (response rate 50–70%; onset of action 2–8 wk; toxicities:

injection-site reactions or infusion reactions, infections,

immunosuppression, possible lymphoma in children)

Dose: 25 mg twice a week or 50 mg/wk SC

Infliximab (response rate 50–70%; onset of action 2–8 wk; toxicities:

injection-site reactions or infusion reactions, infections,

immunosuppression, possible lymphoma in children)

Dose: 3–10 mg/kg IV q. 8 wk with methotrexate

Adalimumab (response rate 50–70%; onset of action 2–8 wk; toxicities:

injection-site reactions or infusion reactions, infections,

immunosuppression, possible lymphoma in children)

Dose: 40 mg SC q. 2 wk (can also be used with methotrexate)

Golimumab (response rate 50–70%; onset of action 2–8 wk; toxicities:

injection-site reactions or infusion reactions, infections,

immunosuppression, possible lymphoma in children)

Dose: 50 mg SC once a month with methotrexate

Certilizumab (response rate 50-70%; onset of action 2-8 wk;

toxicities: injection-site reactions or infusion reactions,

infections, immunosuppression, possible lymphoma in children)

Dose: begin at 200 mg SC q. 2 wk, followed by 200 mg SC q. 4 wk (as a

single agent or with methotrexate)

Interleukin-6 (IL-6) inhibitor

Tocilizumab (response rate 50%-70%; onset of action 2-8 wk;

toxicities: infusion reactions, infections, immune surveillance,

increased liver enzymes, neutropenia, bowel perforations, lipid

alterations)

Dose: 4-8 mg/kg every 4 wk

IL-1 inhibitor

Anakinra (response rate 30%; onset of action 1–3 mo; toxicities:

injection-site reactions, infections)

Dose: 100 mg/day SC

T cell costimulation blocker

Abatacept (response rate 50–70%; onset of action 4-12 wk; toxicities:

injection-site reactions, infections, immune surveillance)

Dose: 500–1,000 mg IV q. 4 wk

B cell depleter

Rixtuximab (response rate 50–70%; onset of action 4-12 wk; toxicities:

infusion reactions, increased infections)

Dose: 500–1,000 mg IV q. 2 wk x 2

Immunosuppressants

Azathioprine (response rate 30–50%; onset of action 2–3 mo;

toxicities: hematologic, immunosuppression, infections, cholestasis)

Dose: 50–150 mg/day

Cyclosporine (response rate 30%; onset of action 2–3 mo; toxicities:

renal [irreversible], hypertension, hypertrichosis, infections,

immunosuppression)

Dose: 2.5–5.0 mg/kg/day

*******************************************

Read the full article here:

http://www.acpmedicine.com/bcdecker/newrxdx/rxdx/dxrx1502.htm

Not an MD

[Guest guest]

To, walker, I am following your comments very closely, you are very

dedicated toward RA support group. You are most often offering your well

reasearched opinions. Hts off to you, very often, I , even being a practicing

Rheumatologist, update myself. Please keep doing this wonderful service to

suffering human kind.

Regards,

Dr. OP Garg, VSM

Blog . Facebook . Twitter

Senior Consultant Rheumatologist

BLK Hospital, Pusa Rd.

Rajendra Place

New Delhi - 110005

RheuMed, The Arthritis Clinic

65A, DDA Pocket 2

Sector 6, Dwarka

New Delhi - 110075

________________________________

From: <Rheumatoid.Arthritis.Support@...>

< >

Sent: Sat, 5 February, 2011 6:42:07 AM

Subject: [ ] INFO - Onset of action and dosage for RA DMARDs /

biologics

American College of Physicians

ACPMedicine.com

S Firestein, MD

Nov 2010

" Rheumatoid Arthritis "

Excerpt from the " Best Therapy " section:

Methotrexate (response rate > 70%; onset of action 6–8 wk; toxicities:

liver [fibrosis, elevated enzymes], teratogen, hematologic, oral

ulcers, alopecia; relative efficacy +++)

Dose: begin at 7.5–10 mg once weekly, then increase to 25 mg/wk over

2–3 mo if necessary; if no response, increase up to 50 mg/wk orally

Leflunomide (response rate 50%; onset of action 2–3 mo; toxicities:

gastrointestinal, liver, skin rash, reversible hair loss, infection,

immunosuppression; teratogen)

Dose: 10–20 mg/day

Hydroxychloroquine (response rate 30–50%; onset of action 2–6 mo;

toxicities: retinopathy, myopathy, hyperpigmentation)

Dose: 200 mg b.i.d.

Sulfasalazine (response rate > 30%; onset of action 2–3 mo;

toxicities: dyspepsia, hemolysis in glucose-6-phosphate dehydrogenase

deficiency)

Dose: 1 g b.i.d. or t.i.d.

Prednisone (response rate > 90%; onset of action < 1 wk; toxicities:

skin atrophy, cataracts, osteoporosis, avascular necrosis, infections,

immunosuppression)

Dose: 5–10 mg/day

Anticytokines

TNF inhibitors

Etanercept (response rate 50–70%; onset of action 2–8 wk; toxicities:

injection-site reactions or infusion reactions, infections,

immunosuppression, possible lymphoma in children)

Dose: 25 mg twice a week or 50 mg/wk SC

Infliximab (response rate 50–70%; onset of action 2–8 wk; toxicities:

injection-site reactions or infusion reactions, infections,

immunosuppression, possible lymphoma in children)

Dose: 3–10 mg/kg IV q. 8 wk with methotrexate

Adalimumab (response rate 50–70%; onset of action 2–8 wk; toxicities:

injection-site reactions or infusion reactions, infections,

immunosuppression, possible lymphoma in children)

Dose: 40 mg SC q. 2 wk (can also be used with methotrexate)

Golimumab (response rate 50–70%; onset of action 2–8 wk; toxicities:

injection-site reactions or infusion reactions, infections,

immunosuppression, possible lymphoma in children)

Dose: 50 mg SC once a month with methotrexate

Certilizumab (response rate 50-70%; onset of action 2-8 wk;

toxicities: injection-site reactions or infusion reactions,

infections, immunosuppression, possible lymphoma in children)

Dose: begin at 200 mg SC q. 2 wk, followed by 200 mg SC q. 4 wk (as a

single agent or with methotrexate)

Interleukin-6 (IL-6) inhibitor

Tocilizumab (response rate 50%-70%; onset of action 2-8 wk;

toxicities: infusion reactions, infections, immune surveillance,

increased liver enzymes, neutropenia, bowel perforations, lipid

alterations)

Dose: 4-8 mg/kg every 4 wk

IL-1 inhibitor

Anakinra (response rate 30%; onset of action 1–3 mo; toxicities:

injection-site reactions, infections)

Dose: 100 mg/day SC

T cell costimulation blocker

Abatacept (response rate 50–70%; onset of action 4-12 wk; toxicities:

injection-site reactions, infections, immune surveillance)

Dose: 500–1,000 mg IV q. 4 wk

B cell depleter

Rixtuximab (response rate 50–70%; onset of action 4-12 wk; toxicities:

infusion reactions, increased infections)

Dose: 500–1,000 mg IV q. 2 wk x 2

Immunosuppressants

Azathioprine (response rate 30–50%; onset of action 2–3 mo;

toxicities: hematologic, immunosuppression, infections, cholestasis)

Dose: 50–150 mg/day

Cyclosporine (response rate 30%; onset of action 2–3 mo; toxicities:

renal [irreversible], hypertension, hypertrichosis, infections,

immunosuppression)

Dose: 2.5–5.0 mg/kg/day

*******************************************

Read the full article here:

http://www.acpmedicine.com/bcdecker/newrxdx/rxdx/dxrx1502.htm

Not an MD

------------------------------------

[Guest guest]

Dr. Garg,

Thank you very much for your kind words and for taking an interest in our group.

Not an MD

On Mon, Feb 7, 2011 at 6:14 AM, onkar prasad garg <onkpg@...> wrote:

> To, walker, I am following your comments very closely, you are very

> dedicated toward RA support group. You are most often offering your well

> reasearched opinions. Hts off to you, very often, I , even being a practicing

> Rheumatologist, update myself. Please keep doing this wonderful service to

> suffering human kind.

>

>  Regards,

> Dr. OP Garg, VSM