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Retinoids used in dermatology. Biological agents used in psoriasis. Side effects of biological therapies. @ Injection site reactions occur with all biologic agents are most commonly seen with etanercept. They are rarely serious.
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Side effects of biological therapies • @ Injection site reactions occur with all biologic agents are most commonly seen with etanercept. They are rarely serious. • @ All biological agents carry a small increased risk of malignancy, especially lymphoma • @ There is an increased risk of infection & serious infections with all biological agents, reactivation of latent tuberculosis is well recognized. • @ Anti-TNF biological agents are associated with a new onset demyelinating disorders & exacerbation of pre-existing multiple sclerosis. • @ Some patients develop ANA antibodies while on biological therapies, only rarely does this lead to a drug induced lupus which tends to resolve on stopping the medication. • @ Patients may develop antibodies to the biological agents but this is only clinically relevant for infliximab where antibodies are associated with an increased risk of an infusion reactions & reduced efficacy
Side effects of biological therapies (continue) • 2O% of patients on infliximab develop non serious infusion reactions such as headache, flushing & nauseas; 1%develop serious reactions such as anaphylaxis, hypotension & chest pain • @ Adalimumab can be associated with leucopenia & thrombocytopenia, aleacept with lymphopenia & efalzumab with thrombocytopenia. • ******************* • Absolute contraindications include sensitivity to the drug, pregnancy & active or chronic infection • Relative contraindications include a family or personal history of demyelinating diseases, history of malignancy & concomitant immunosuppressive treatment.. Congestive cardiac failure is a contraindication for infliximab & etanercept.. Thrombocytopenia is a contraindication for treatment with efalizumab & lymphopenia is a contraindication for using alefacept
If you are obliged to change from oral corticosteroid (e.g. due to vomiting) to systemic corticosteroid; the equivalent doses of commonly used systemic steroids are: • If a patient is taking 8Omg/ day of predinosolone orally , this is equal to 12 mg dexamethasone systemically