L4-Anti-rheumatic dr..
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Transcript L4-Anti-rheumatic dr..
BY
PROF.
AZZA EL-MEDANY
DR.
OSAMA YOUSIF
General Features &
Conditions to use antirheumatic
Low doses are commonly used early in the course of
the disease
Used when the disease is progressing & causing
deformities
Used when the inflammatory disease is not
responding to NSAIDs
Can not repair the existing damage , but prevent
further deformity
Have no analgesic effects
Slow onset their effects take from 6 weeks up to 6
months to be evident
General Clinical Uses
Treatment of rheumatic disorders
Combination therapies are both
safe & efficacious
Hydroxychloroquine
Mechanism of action :
Trapping free radicals
Suppression of T lymphocyte cells
Pharmacokinetics
Rapidly & completely absorbed following oral
administration.
Penetrates into C.N.S. & traverse the placenta
Metabolized in liver
Adverse Effects
Pruritus
GIT upset
Discoloration
of nail beds &
mucous
membranes
Headaches
Blurred
vision
Irreversible
retinal
damage
Methotrexate
Immunosuppressant drug
Used mainly as chemotherapy for cancer
treatment
Doses of methotrexate as antirheumatic are
much lower than those needed in cancer
chemotherapy
Given once a week
Mechanism of action
Inhibition of T-Cells ( cell-mediated immune
reactions)
Nausea
Liver
cirrhosis
Mucosal
ulceration
Cytopenia
Adverse Effects
Acute
pneumonia –
like
syndrome
Biologic disease modifiers
Genetically engineered drugs that are used to
modify imbalances of the immune system in
autoimmune diseases.
Some of these agents block, or modify the activity
of selected cells in the immune system, while
others –including tocilizumab work by blocking
certain messenger proteins known as cytokines ,
that send signals between those cells.
Classification of biologic disease
modifiers
T-cell modulating drug ( abatacept )
B-cell cytotoxic agent
( rituximab )
Anti-IL-6 receptor antibody ( tocilizumab)
TNF- blocking agents
( infliximab)
Tocilizumab
IL-6 receptor inhibitor
Binds to membrane IL-6 receptors ,blocking the
activity of IL-6 in mediating signals
Half-life is dose dependent (11-13 days )
Given as monthly IV infusion
Used as monotherapy in adult with rheumatoid
arthritis or in children over 2 years with systemic
juvenile arthritis
Cont.
Can be given in combination with methotrexate
or other non biologic anti-rheumatic drugs in
patients with active rheumatoid arthritis .
Side effects
Severe infusion reactions
Serious infections ( bacterial, tuberculosis ,fungal
Increase in cholesterol level
Increase in liver enzymes
Decrease in WBCs
Blood tests will be used monthly for increase in
cholesterol, liver enzymes & decrease in WBCs
Drug Interaction
In combination of tocilizumab with some drugs such
as cyclosporine or warfarin
{IL-6 inhibits CYP450, this enzyme is essential for the
metabolism of cyclosporine or warfarin.
Tocilizumab which act as inhibitor for IL-6 ,resulting in
restoring the activity of the enzyme }
Tumor necrosis factor –α
(TNF-α ) blocking agents
Infliximab
A chimeric antibody ( 25% mouse,
75% human)
Mechanism of action
Binds to human TNF-α resulting in inhibition of
its action as a mediator in inflammatory diseases
Infliximab
Given as IV infusion over at least two hours
Half-Life 8-12 days
Given every 8 weeks regimen.
Elicits up to 62% incidence of human antichimeric
antibodies.
Concurrent therapy with methotrexate decreases
the prevalence of human antichimeric antibodies
Upper
respiratory
tract infections
Pancytopenia
Adverse
effects
Activation of
latent
tuberculosis
Infections
Infusion
reactions
Comparison between NSAIDs &
DMARDs
DMARDs
Slow onset of action used in
chronic cases when deformity
is exciting
Arrest progression of the
NSAIDs
Rapid onset of action used in
acute cases to relief
inflammation & pain
No effect
disease
Can not stop formation of
Prevent formation of new
deformity
new deformity