• Biologics

    Biological medicines, also known as biological therapies or “biologics,” are medicines that are produced by living organisms, including human, animal, or microorganism cells. Today, they are commonly produced through biotechnology. Biologics can include proteins, sugars, and nucleic acids, as well as living entities such as gene therapies.

  • Commonly seen side effects with Adalimumab (ADA)

    Infections, injection site reaction, headache & rash.

  • How do biologics work?

    Biologics work by targeting particular chemicals or cells involved in the body’s immune system response. Anti-TNF drugs, for example, were the first biologics to be developed. These therapies work by blocking the activity of TNF, a chemical messenger. TNF itself has many different actions, so anti-TNF drugs result in many biological effects, which tend to reduce or stop different aspects of inflammation.

  • Vaccinations needs to be done during Biologic therapy

    Vaccination should be given before starting treatment (e.g. influenza, polysaccharide Pneumovax, Hep B) and then during as appropriate when indicated. Live attenuated vaccines (e.g. BCG, yellow fever, herpes zoster and oral polio) are not recommended

  • Pre -screening test before starting the biologics

    • Consider three monthly ESR and CRP, Full Blood Count, Renal and Liver Function tests
    • Chest x-ray (pre biologic and post if respiratory symptoms or LTBI follow up, or smoker)
    • Two Step Tuberculin Skin Test and / QuantiFERON assay (pre biologic) and post if reexposure to TB is occurring
    • Hepatitis B and C serology (pre biologic and annually if appropriate)
    • HIV screening should be considered in at risk patients
    • ANA, dsDNA, RF, anti-CCP initially pre biologic

    These maybe repeated if appropriate (e.g. ANA, dsDNA if development of clinical SLE symptoms). The frequency and type of tests will also be influenced by usual monitoring requirements for other DMARDs if being used in combination with the TNFi.

  • Biologics and Pregnancy

    Yes during pregnancy up to 1st Trimester if required and lactating mother also.

  • Administration of ADA?

    Adalimumab, given by subcutaneous injection with a special pre-filled syringe.

  • Contra-indication

    ADA should not be administered to the patients with hypersensitivity. Before you start taking biologics you should tell your doctor if you had any of following

    • Any kind of infection that keeps coming back
    • If you ever had TB
    • If you experience any numbness or tingling
    • If you scheduled to have major surgery
    • If you scheduled to be vaccinated for anything
  • What is the risk of TB?

    Incidence rate of TB is < 0.1% in the patients treated more than 5 years with Ada

  • Minimum and maximum age to prescribe ADA

    Minimum age is to start Ada is 2 year and there is no data suggesting maximum age limit for Ada therapy but be caution while treating elderly.

  • What are the drugs that cannot be given with ADA

    With other biologic DMARDS (e.g., Anakinra, abatacept) or other TNFi is not recommended.

  • Can patients with Liver cirrhosis can take Ada?

    Yes.