Adverse Effects and Drug Interactions of Biologic Agents

The document from 2010 examines the adverse effects and drug interactions of biologic agents, particularly TNF-alpha antagonists, used in treating rheumatic diseases. It notes that these agents are effective but carry risks of serious adverse effects, including infections, malignancy, congestive cardiac failure, hematological disorders, vasculitis, neurological complications, and dermatological issues. Infections are the most significant concern, with a meta-analysis showing a 3.6% serious infection rate in patients on infliximab and adalimumab versus 1.7% in control groups. The risk of tuberculosis is higher with infliximab and adalimumab than with etanercept. Hematological disorders like aplastic anemia and pancytopenia, vasculitis, seizures, and injection site reactions are also associated with these agents. The document stresses the importance of monitoring for infections, especially tuberculosis, before and during treatment with TNF-alpha antagonists. Other biologic agents like abatacept, rituximab, anakinra, golimumab, and tocilizumab are discussed, each with its own profile of adverse effects and recommended monitoring strategies. The document concludes that while biologic agents can cause various adverse effects, informing patients and careful monitoring are essential, and switching between antiTNF-alpha agents may be beneficial if adverse effects or lack of response occurs.