Non-TNF biologic DMARDs
(Redirected from Actemra)
| Drug monograph · NCLEX study reference | |
| Trade names | Rituxan, Actemra, Stelara, Cosentyx, Dupixent, Orencia, Kineret |
|---|---|
| Therapeutic class | Biologic immunomodulators |
| Pharmacologic class | Monoclonal antibodies and receptor antagonists targeting specific immune pathways (CD20, IL-6, IL-12/23, IL-17, IL-4/13, T-cell costimulation, IL-1) |
| Onset / peak / duration | Effect over weeks; IV or SubQ by agent. |
| Half-life / level | Long; dosed at intervals from daily (anakinra) to every several weeks or months. |
| Routes | IV, SubQ |
| High-alert (ISMP) | No |
| Black box warning | Yes (see Safety) |
| Antidote / reversal | Supportive care; manage infusion reactions. |
| Pregnancy / lactation | Case by case under specialist guidance. |
Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.
Non-TNF biologic DMARDs (brand names Rituxan, Actemra, Stelara, Cosentyx, Dupixent, Orencia, Kineret) — Biologic immunomodulators; Monoclonal antibodies and receptor antagonists targeting specific immune pathways (CD20, IL-6, IL-12/23, IL-17, IL-4/13, T-cell costimulation, IL-1).
Identification
- Therapeutic class: Biologic immunomodulators.
- Pharmacologic class: Monoclonal antibodies and receptor antagonists targeting specific immune pathways (CD20, IL-6, IL-12/23, IL-17, IL-4/13, T-cell costimulation, IL-1).
Pharmacology
- Mechanism of action: Each blocks a specific immune target to reduce inflammation.
- Onset / peak / duration: Effect over weeks; IV or SubQ by agent.
- Half-life / therapeutic level: Long; dosed at intervals from daily (anakinra) to every several weeks or months.
Clinical use
- Indications: Rheumatoid arthritis, psoriasis and psoriatic arthritis, inflammatory bowel disease, atopic dermatitis and asthma (dupilumab), certain lymphomas and vasculitis (rituximab).
- Usual dose, route, frequency: IV infusion (rituximab, tocilizumab, some) or SubQ (others) at agent-specific intervals.
- Maximum dose / adjustments: Hold for serious infection; screen for tuberculosis and hepatitis as appropriate.
Safety
- Contraindications: Active serious infection; agent-specific cautions.
- Black box warning: Rituximab carries boxed warnings for fatal infusion reactions, severe mucocutaneous reactions, hepatitis B reactivation, and progressive multifocal leukoencephalopathy; tocilizumab carries a boxed warning for serious infections.
- Interactions: Other immunosuppressants (infection), live vaccines (avoid), tocilizumab affects CYP substrates.
- Pregnancy / lactation: Case by case under specialist guidance.
- High-alert: No.
Adverse effects
- Common side effects: Infusion or injection reactions, upper respiratory infections, headache.
- Serious effects to report: Serious infections, hepatitis B reactivation (rituximab), neurologic symptoms (PML), GI perforation (tocilizumab, with diverticulitis), conjunctivitis (dupilumab).
- Antidote / reversal: Supportive care; manage infusion reactions.
Nursing process
- Assessment before administration: Infection screening, hepatitis B status (rituximab), premedication for infusions, vaccination status.
- Interventions during therapy: Premedicate and monitor closely during rituximab infusions; avoid live vaccines; hold for infection.
- Monitor: Infusion reactions, infection, hepatitis (rituximab), neurologic status.
- Evaluation / expected outcome: Reduced disease activity.
Patient teaching
- Patient teaching: Report infections and infusion reactions; avoid live vaccines.
- Notify provider if: Fever or infection, severe infusion reaction, new neurologic symptoms.
- Administration tips: Infusion monitoring and premedication for IV agents; SubQ rotation for others.