C H A P T E R 1 7
Immune modulators
265
Contraindications and cautions
The use of T- and B-cell suppressors is contraindicated
in the presence of any known allergy to the drug or its
components and during pregnancy and breastfeeding
because of the potential serious adverse effects on the
fetus or neonate.
Caution should be used with renal
or hepatic impairment,
which could interfere with the
metabolism or excretion of the drug
, and in the presence
of known neoplasms,
which potentially could spread
with immune system suppression
.
Adverse effects
People receiving these drugs are at increased risk for
infection and for the development of neoplasms due
to their blocking effect on the immune system. Other
potentially dangerous adverse effects include hepato
toxicity, renal toxicity, renal dysfunction and pulmonary
oedema. Individuals may experience headache, tremors
and secondary infections such as acne, GI upset, diar-
rhoea and hypertension.
TABLE 17.2
DRUGS IN FOCUS Antianginal agents (continued)
Drug name
Dosage/route
Usual indications
Monoclonal antibodies (continued)
golimumab (Simponi)
50 mg SC once monthly
Management of moderate to severe active
rheumatoid arthritis, progressive psoriatic
arthritis, active ankylosing spondylitis
infliximab (Remicade)
5 mg/kg IV over 2 hours; may be repeated at 2
and 6 weeks
Decreases signs and symptoms of
Crohn’s disease in individuals who do
not respond to other therapy; treatment
of fistulating Crohn’s disease; also
approved for use with methotrexate in
the treatment of progressing moderate
to severe rheumatoid arthritis
omalizumab (Xolair)
150–375 mg SC every 2–4 weeks
Treatment of asthma with a very strong
allergic component and seasonal allergic
rhinitis not well controlled with traditional
medications
palivizumab (Synagis)
15 mg/kg IM as a single dose at the start of
respiratory syncytial virus (RSV) season
Prevention of serious RSV infection in
high-risk children
panitumumab (Vectibix)
6 mg/kg IV every 2 weeks
Treatment of wild type KRAS metastatic
colorectal cancer
rituximab (Mabthera)
375 mg/m
2
IV once weekly for four doses
Treatment of relapsed follicular B-cell
non-Hodgkin lymphoma
tocilizumab (Actemra)
4–8 mg/kg IV every 4 weeks, with
methotrexate
Relief of signs and symptoms of moderate
to severe rheumatoid arthritis in adults
trastuzumab (Herceptin,
Kadcyla)
4 mg/kg IV over 90 minutes, then 2 mg/kg IV
once a week over at least 30 minutes
Treatment of metastatic breast cancer
with tumours that overexpress human
epidermal growth factor receptor 2 (HER2)
ustekinumab (Stelara)
45–90 mg by SC injection once a week,
progressing to once a month, then once
every 3 months as determined by individual
condition and response
Treatment of recalcitrant plaque psoriasis
in adults not responsive to traditional
therapy
Prototype summary: Cyclosporin
Indications:
Prophylaxis for organ rejection
in kidney, liver and heart transplants (used
with corticosteroids); treatment of chronic
rejection in people previously treated with other
immunosuppressants; treatment of rheumatoid
arthritis and recalcitrant psoriasis.
Actions:
Reversibly inhibits immunocompetent
lymphocytes; inhibits T helper cells and
T suppressor cells, lymphokine production, and
release of interleukin-2 and T-cell growth factor.
Pharmacokinetics:
Route
Onset
Peak
PO
Varies
3.5 hours
IV
Rapid
1–2 hours
T
1/2
:
19 to 27 hours; metabolised in the liver and
excreted in the bile and urine.
Adverse effects:
Tremor, hypertension, gum
hyperplasia, renal dysfunction, diarrhoea,
hirsutism, acne, bone marrow suppression.
