Medication | Effect on immune system | Associated infections* | Pre-treatment testing¶ | Pre-treatment vaccinationsΔ |
TNFi | ||||
Infliximab | Inhibits macrophage activation and granuloma formation and function | Bacterial:
Fungal:
Parasitic:
| Test for:
|
|
Etanercept◊ | ||||
Adalimumab | ||||
Certolizumab pegol | ||||
Golimumab | ||||
Anti-T cell agents | ||||
Abatacept | Inhibits CD80/CD86, thus preventing suppression of regulatory T cell activity | Bacterial:
Viral:
| Test for:
|
|
Janus Kinase (JAK) inhibitors | ||||
Ruxolitinib | Inhibits JAK signaling and disrupts signaling pathways involved in immune cell (eg, NK cells, macrophages, T cells) activation and migration | Bacterial:
Viral:
Fungal:
| Test for:
|
|
Tofacitinib | ||||
Baricitinib | ||||
Other (upadacitinib, filgotinib, peficitinib, abrocitinib) |
CMV: cytomegalovirus; EBV: Epstein-Barr virus; HBV: hepatitis B virus; HCV: hepatitis C virus; HIV: human immunodeficiency virus; JCV: John Cunningham virus; NK cells: natural killer cells; PML: progressive multifocal leukoencephalopathy; RZV: recombinant (non-live) zoster vaccine (Shingrix); TBI: tuberculosis infection.
* In addition to the infections listed, typical, common bacterial, and viral infections should also be considered in the differential when infection is suspected in a patient taking the specified agent.
¶ For patients who do not have a negative HIV test documented in their records or are at increased risk of acquiring HIV (eg, men who have sex with men, engagement in sex work), the pretreatment infectious testing process is a good opportunity to provide routine HIV screening prior to the initiation of immunosuppression. Treat any infections found on pre-treatment testing. Control of infection should be demonstrated prior to initiating immunosuppressive therapy.
Δ Live and non-live vaccines should be administered no later than 4 and 2 weeks, respectively, prior to initiating therapy. Vaccine responses may be attenuated while on therapy.
◊ Etanercept is associated with a lower risk of tuberculosis (TB) compared to the other TNFi.Do you want to add Medilib to your home screen?