II. Indications

  1. Moderate to severe refractory Crohn's Disease
  2. Refractory Rheumatoid Arthritis
    1. Added to Methotrexate or with other agents

IV. Mechanism

V. Pharmacokinetics

  1. Half life of 5 mg/kg single dose: 10 days

VI. Disadvantages

  1. Cost: $2380/dose (cost to pharmacist)

VII. Dose: Crohn's Disease

  1. Initial: 5 mg/kg IV infusion over 2 hours
  2. Repeat at 2 weeks and 6 weeks for fistulas

VIII. Dose: Rheumatoid Arthritis

  1. Initial: 3 mg/kg IV at 0 weeks, 2 weeks and 6 weeks
  2. Maintenance: 3 mg/kg IV every 8 weeks (6x/year)
  3. Dosing range is 3-10 mg/kg (typically higher doses than 3 mg needed with longterm use)

IX. Efficacy: Crohn's Disease

  1. Significant response to remission even with fistulas
  2. Relapse may occur after 3 months

X. Adverse effects

  1. Safety of repeated use unknown
  2. Serum Sickness
  3. Lymphoma
  4. Opportunistic Infection
    1. Associated with Granulomatous infection
      1. Tuberculosis
      2. Histoplasmosis
    2. Higher risk of infection than with Etanercept
      1. Wallis (2004) Clin Infect Dis 38:1261-5 [PubMed]

XI. Drug Interactions

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