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TNF a inhibitors

TNF a inhibitors

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TNF a inhibitors

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  1. TNF a inhibitors BY: MOHAMMED ALSAIDAN

  2. Biologics Biologic agents are proteins that can be extracted from animal tissue or produced by recombinant DNA technology and possess pharmacologic activity

  3. TNF a • TNF a is a major cytokine produced by Th1 cells, APC and keratinocytes • TNF a in the lesion and serum level correlate with severity of psoriasis • TNF potentiate Th1 response, up-regulate intracellular and vascular adhesion, cause keratinocytes proliferation and potentiate other cytokines

  4. TNF a adverse effects • Viral, bacterial and mycobacterial infections (less with etanercept) ( HCV ?!) • Neurologic disease • Heart disease • Drug induced lupus-like syndrome • Hepatic disease (infliximab) • Lymphoma • Melanoma and non-melanoma skin cancer • Haematologic disease

  5. Monitoring • PPD +/- CXR • CBC , U/E , LFT • Hepatitis panel • ANA

  6. Injections • Should not be frozen • Stable for 14 days • Allow for return to room temp before injection • Site : thigh, abdomen, upper arms • Rotate injection site

  7. Indications for Etanercept • FDA approved for psoriasis and psoriatic arthritis • Off label dermatologic uses: • Neutrophilicdermatoses: PG, behcet , aphthous stomatitis • Bullous dermatoses: PV, CP • Sarcoidosis • DM, relapsing polychondritis • GVHD, hidradenitissuppurativa, multicentricreticulohistiocytosis

  8. T cell activation inhibitors

  9. IL 12/23 blockage (Ustekinumab) • The p40 subunit of IL 12 is overexpressed in psoriasis • It is a human monoclonal antibody • Superior to etenercept • Given 45 mg S.C at weeks: 0,4, 16, 28

  10. THANK YOU