Biologic Anti-inflammatory Drugs

Biologic anti-inflammatory medications are used in the treatment of various anti-inflammatory disorders such as ulcerative colitis, Crohn's disease, rheumatoid arthritis, psoriasis, and ankylosing spondylitis.  These medications modulate the immune system by binding to inflammatory mediators such as TNF-alpha (adalimumab, certolizumab, etanercept, golimumab, and infliximab*), T-cell antigens (abatacept), B-cell antigens (rituximab), interleukin receptors (*tocilizumab and anakinra), and Janus kinase (jk) inhibitors (tofacitinib). Increased risks of infections and malignancy are common with these medications as immune response is lessened. Additionally blood dyscrasias and rashes can occur.

Class Drugs

• Adalimumab

• Certolizumab

• Etanercept

• Golimumab

• Infliximab

• Abatacept

• Rituximab

• Tocilizumab

• Tofacitinib

• Anakinra

Class Mechanism of Action

See individual drugs

Class Applications

See individual drugs

Class Adverse Effects

See individual drugs

Drug Table

Drug Name	Application	Comments	Image
Adalimumab	Rheumatoid arthritis; Psoriatic arthritis; Crohn's Disease; Ankylosing spondylitis	Mechanism of Action; -Monoclonal antibody that binds TNF-alpha; -Decreases ability of TNF-alpha to interact with cell receptors; Adverse Effects; -Agranulocytosis; -Rash; -Increased risk of infections, may be serious; -Increased risk of malignancy	"Ad" "Limo" "MAD magazine"
Certolizumab	Rheumatoid arthritis; Psoriatic arthritis; Crohn's Disease; Ankylosing spondylitis	Mechanism of Action; -Fab fragment of antibody used to block TNF-alpha; Adverse Effects; -Agranulocytosis; -Rash; -Increased risk of infections that can be serious (URI, UTI, etc.) and fungal infections; -Increased risk of malignancy, especially lymphoma	"Serta Mattress" "Lizard" "MAD magazine"
Etanercept	Rheumatoid arthritis; Psoriasis; Ankylosing spondylitis	Mechanism of Action; -Recombinant human receptor fusion protein; -Binds TNF-alpha, blocks effects; Adverse Effects; -Agranulocytosis; -Rash; -Increased risk of infections that can be serious (URI, UTI, etc.) and fungal infections; -Increased risk of malignancy, especially lymphoma	"Tan" "Scepter"
Golimumab	Rheumatoid arthritis; Psoriatic arthritis; Ankylosing spondylitis	Mechanism of Action; Monoclonal antibody that binds TNF-alpha; Adverse Effects; -Rash; -Increased risk of infections that can be serious (URI, UTI, etc) and fungal infections; -Increased risk of malignancy	"Gollum" "MAD magazine"
Infliximab	Rheumatoid arthritis; Plaque psoriasis; Psoriatic arthritis; Ankylosing spondylitis; Ulcerative colitis; Crohn's Disease	Mechanism of Action; -Monoclonal antibody that binds TNF-alpha; -Decreases actions of TNF-alpha; Adverse Effects; -Rash; -Increased risk of infections that can be serious (URI, UTI, etc) and fungal infections; Increased risk of malignancy; -Reactivation of latent infections	"Netflix" "MAD magazine"
Abatacept	Rheumatoid arthritis	Mechanism of Action; -Recombinant protein; -Limits full T-cell activation by interfering with binding of CD28 on the T-cell and the CD80/CD86 protein on the antigen presenting cell (B cell or macrophage); Adverse Effects; -Headache; -Nausea; -Increased risk of infections	"Bat" "Scepter"
Rituximab	Rheumatoid arthritis	Mechanism of Action; -Monoclonal antibody that binds CD20 antigen on B cells causing decreased levels of B cells; -B cells perpetuate inflammatory response by producing inflammatory cytokines, rheumatoid factor, and auto-antibodies and by activating T-cells; Adverse Effects; Infusion reactions (limited by administration of methylprednisolone prior to rituximab infusion)	"Ritz Crackers" "Tuxedo" "MAD magazine"
Tocilizumab	Rheumatoid arthritis	Mechanism of Action; Monoclonal antibody that blocks IL-6 receptor	"Tic Toc" "Liz" "MAD magazine"
Tofacitinib	Rheumatoid arthritis	Mechanism of Action; -Inhibits Janus kinases; -Janus kinases increase activity intracellularly in response to inflammatory mediators, which activates the immune system; Adverse Effects; -Metabolized by CYP3A4, so dosing adjustments may be necessary when other drugs that induce or inhibit they CYP3A4 enzyme; -Anemia, Hgb must be greater than 9; -Increases risk of infections; -Increases risk of malignancy	"Toe" "Fact" "Nibs"
Anakinra	Rheumatoid arthritis	Mechanism of Action; -IL-1 receptor antagonist; -IL-1 mediates cartilage degradation and bone resorption; Adverse Effects; Neutropenia	"Anna Karenina"