Table 1: Properties of TNF-a Inhibitors
|
|
Elimination half-life (days) |
Fixes complement; antibody-mediated cell lysis |
|
Etanercept (Embrel) |
4.2 |
No |
|
Infliximab (Remicade) |
9.5 |
Yes |
|
Adalimumab (Humara) |
14 |
Yes |
|
Certolizumab (Cimzia) |
14 |
No |
|
Golimumab (Simponi) |
7 to 20 |
Unknown |
Data from:
Table 2: Infections Associated with TNF-a Inhibitors
|
Viral
Bacterial Escherichia coli Mycobacterium avium spp. or xenopi Salmonella spp. Staphylococcus spp.
Fungal Aspergillus spp. Blastomycosis Candida spp. Cryptococcus spp.
Adapted from Pappa A, et al. Use of infliximab in particular clinical settings: management based on current evidence. Am J Gastroenterol. 2009;104(6):1575-86. Epub 2009 Apr 28. [PubMed] |
Table 3: Dutch Society for Rheumatology: Recommendations for Perioperative Management of TNF-a Inhibitors
|
Infliximab Discontinue 39 days prior to surgery Etanercept Discontinue 12 days prior to surgery Adalimumab Discontinue 56 days prior to surgery
Crawford M, Curtis JR. Tumor necrosis factor inhibitors and infection complications. Curr Rheumatol Rep 2008;10:383. [PubMed] |
Table 4a: Recommended vaccinations prior to administration of TNF-a Inhibitors
|
Pneumococcal vaccine Trivalent inactivated influenza vaccine Hepatitis B vaccination series (patients at high risk) |
Table 4b: Live Vaccinations that are Contraindicated During Anti-TNF Therapy
|
Nasal influenza vaccine Oral polio vaccine Measles/mumps/rubella vaccine Yellow fever vaccine Smallpox vaccine Zoster vaccine |
Table 5: Screening Recommendations Prior to Administration of TNF-a Inhibitors
|
Screening for latent TB TST with standard PPD (5 mm or more of induration considered positive) Repeat testing (boosting) should be considered after 7 to 10 days if TST is negative Chest x-ray if suspicion for latent TB is high Further studies are needed before QFT-G can be strongly recommended as a routine screening test for latent TB in patients receiving anti-TNF therapy
Screening for latent fungal infections Chest x-ray and serologic testing for Coccidioides should be considered for patients who live in endemic areas Chest x-ray if travel to endemic areas for Histoplasma has occurred, if histoplasmosis or pneumonia was diagnosed within 2 years, or if symptoms suggestive of histoplasmosis occurred within 3 months
Screening for hepatitis B Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis B core antibody (anti-HBc) Hepatitis B viral load (HBV DNA) if HBsAg is positive
|