II. Indications
- Moderate to severe refractory Crohn's Disease
- Refractory Rheumatoid Arthritis
- Added to Methotrexate or with other agents
III. Contraindications
IV. Mechanism
- Anti-TNF alpha Monoclonal Antibody
- Monoclonal Antibody binds Tumor Necrosis Factor alpha
V. Pharmacokinetics
- Half life of 5 mg/kg single dose: 10 days
VI. Disadvantages
- Cost: $2380/dose (cost to pharmacist)
VII. Dose: Crohn's Disease
- Initial: 5 mg/kg IV infusion over 2 hours
- Repeat at 2 weeks and 6 weeks for fistulas
VIII. Dose: Rheumatoid Arthritis
- Initial: 3 mg/kg IV at 0 weeks, 2 weeks and 6 weeks
- Maintenance: 3 mg/kg IV every 8 weeks (6x/year)
- Dosing range is 3-10 mg/kg (typically higher doses than 3 mg needed with longterm use)
IX. Efficacy: Crohn's Disease
- Significant response to remission even with fistulas
- Relapse may occur after 3 months
X. Adverse effects
- Safety of repeated use unknown
- Serum Sickness
- Lymphoma
- Opportunistic Infection
- Associated with Granulomatous infection
- Higher risk of infection than with Etanercept
XI. Drug Interactions
- Acetaminophen
- Benadryl
- Solu-Medrol
- Epinephrine