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Compatibility of commonly used drugs in lactation
Published in Amy Brown, Wendy Jones, A Guide to Supporting Breastfeeding for the Medical Profession, 2019
Babies of mothers with IBD on monoclonal antibodies should avoid live vaccines, especially rotavirus due to shedding into faeces. The mother is at risk of contracting virus from these. If vaccination is given, mother should wear gloves and be careful with hand hygiene. Infliximab – molecular weight 149,100. Poor oral bioavailability, RID 0.32–3.01%.Adalimumab – molecular weight 148,000. Poor oral bioavailability, RID 0.12%.Golimumab – molecular weight 150,000. Poor oral bioavailability.Certolizumab pegol – molecular weight 149,100. Poor oral bioavailability. RID 0.04–0.3%. Licensed for use in breastfeeding.
Immune system modulators
Published in Gabriel Virella, Medical Immunology, 2019
Richard M. Silver, Stephen Elmore
TNF has been implicated as one of the primary cytokines responsible for inflammation in several diseases, including rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Several different medications have been developed to inhibit TNF in a number of ways. Etanercept exists as an artificial, plasma-based version of the TNF receptor that binds to TNF before it is able to interact with cell-bound receptors and initiate the inflammatory cascade. It is typically administered as a weekly subcutaneous injection. Infliximab is a monoclonal anti-TNF antibody that is a murine/human hybrid. It functions by binding and neutralizing TNF in the plasma and is given as an IV infusion every 6–8 weeks. Due to its chimeric nature, however, use of this medication can lead to development of antichimeric antibodies that can lower the functional level of the drug, making it less effective. Adalimumab differs in that it is a fully humanized monoclonal antibody to TNF. This theoretically lowers the immunogenicity of the molecule. Adalimumab is given as a subcutaneous injection every 7–14 days. Similar to adalimumab, golimumab also is a monoclonal antibody, and its longer half-life allows the medication to be given on a monthly basis subcutaneously or every 2 months intravenously. Finally, certolizumab is another TNF inhibitor, in this case a pegylated F(ab′)2 fragment of anti-TNF antibody. Its half-life is shorter (11 days) and thus it needs to be administered initially every 2 weeks and every 4 weeks for maintenance of its effects.
Information on level of drugs into breastmilk
Published in Wendy Jones, Breastfeeding and Medication, 2018
Golimumab is a human monoclonal antibody to TNF α with similar activity to others in this class. It is used to treat severe UC in patients who have shown an inadequate response to other treatments and/or are corticosteroid dependant.
Biological treatment for erythrodermic psoriasis
Published in Expert Opinion on Biological Therapy, 2022
Golimumab is a fully human anti-TNF-α monoclonal antibody approved to treat psoriatic arthritis, rheumatoid arthritis, and ankylosing spondylitis. Use of golimumab in psoriatic erythroderma was first reported by Lee et al. A 32-year-old man who had failed conventional oral therapies and phototherapy was treated with golimumab 50 mg [38]. Rapid response was noted as >50% reduction in PASI within 4 weeks. Efficacy was maintained at 11 months with monthly golimumab injections without any significant adverse effects. Kudsi et al. described rapid response to golimumab in two EP patients [39]. PASI score improved in both patients from 39.1 and 41.9 at baseline to 17.1 and 14.8 at 4 weeks, respectively. Psoriatic exfoliative erythroderma following golimumab injection for rheumatoid arthritis has been described [40].
Effect of biological DMARDs and JAK inhibitors in pain of chronic inflammatory arthritis
Published in Expert Opinion on Biological Therapy, 2022
Alessandra Alciati, Marco Di Carlo, Cesare Siragusano, Antonino Palumbo, Ignazio Francesco Masala, Fabiola Atzeni
Certolizumab pegol is the first poly (ethylene glycol) (PEG)ylated, Fc-free anti-TNFα. The attachment of a PEG chain to the Fab′ fragment increases its half-life to a mean of 14 days, allowing a once-a-month subcutaneous dosing regimen. In the 24-week FAST4WARD trial, certolizumab pegol showed a rapid efficacy of action on pain, with a reduction of 16.7 on a VAS 0–100 scale just after 1 week of treatment and 20.6 at the end of the study [33]. Golimumab is a transgenic and anti-TNF monoclonal antibody that acts primarily by targeting and neutralizing TNFα, thus preventing inflammation. The GO-AFTER study, that considered aggregated data for the 50 and 100 mg dosages of golimumab, documented a reduction in VAS pain (0–10 cm) of 30.9% at 14 weeks and 32% at 24 weeks [34].
Clinical effectiveness of golimumab in ulcerative colitis: a prospective multicentre study based on the Swedish IBD Quality Register, SWIBREG
Published in Scandinavian Journal of Gastroenterology, 2021
Carl Eriksson, Isabella Visuri, Lina Vigren, Linda Nilsson, Anders Kärnell, Henrik Hjortswang, Daniel Bergemalm, Sven Almer, Erik Hertervig, Per Karlén, Hans Strid, Jonas Halfvarson
Golimumab therapy was administered subcutaneously according to the EU Summary of Product Characteristics recommendation, at an initial dose of 200 mg, followed by 100 mg at week 2. Thereafter, patients with a body weight of <80 kg and patients with a body weight of ≥80 kg received golimumab maintenance doses of 50 mg or 100 mg every four weeks, respectively [9,10]. However, this was an observational study and the treating physician was allowed to adjust the dose or change the interval between injections at any time. Reasons for discontinuation of golimumab and previous anti-TNF therapy were classified at the discretion of the investigator. The criteria for discontinuation of treatment were harmonised with the SWIBREG, and included primary non-response, secondary loss of response, intolerance (discontinuation due to side effects) or other reasons, including pregnancy.