II. Indications

  1. Severe active Rheumatoid Arthritis refractory to DMARDs

III. Contraindications

  1. Chronic or acute infection
  2. Concurrent use of TNF Antagonists (infection risk)
    1. Adalimumab (Humira)
    2. Etanercept (Enbrel)
    3. Infliximab (Remicade)

IV. Mechanism

  1. Interleukin-1 Receptor Antagonist

V. Dosing

  1. Adults: 100 mg SC qd with rotating injection sites

VI. Cost

  1. Vial of 100 mg/0.67 ml (7 doses): $260

VII. Adverse Effects

  1. Immunosuppression
    1. Use caution in any patient prone to infection
  2. Headache
  3. Injection site inflammation
  4. Gastrointestinal upset
  5. Leukopenia (including Neutropenia)

VIII. Monitoring

  1. Serum Creatinine
  2. Complete Blood Count with Neutrophil Count
    1. Baseline, then
    2. Monthly for 3 months, then
    3. Quarterly

IX. References

  1. (2003) Lexicomp Drug Database

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