Biologic immunomodulators

Background

• Immunomodulators created by a mouse or human cell that either create antibodies or targets against various cell lines that are receptor based. They interact with cellular immunity such as tumor necrosis factor alpha and interleukins.
• The agent's uses range from a wide array of indications such as Crohn's disease, Ulcerative colitis and Inflammatory bowel disease, Rheumatoid arthritis, Psoriatic arthritis, Ankylosing spondylitis and many malignancies with specific receptors.

Naming

The various letters chosen in the name indicated the structure, origin, and targets of the molecule. For example ixekizumab for psoriasis ends with –mab, so it is a monoclonal antibody, has a –u- so it is human and has –ki- which means that it is interleukin targeted.

Suffix

• -mab means a monoclonal antibody
• –cept indicates a protein that mimics an immunoglobulin.

Middle syllable

• –u- means all human derived
• -o- means all mouse derived
• -zu- means humanized after being mouse derived
• –xi- means part-human and part-non human.

Middle bridging syllable

This lettering can indicate the biologic's target

• t- means tumor is the target.
• –ba- means there is bacterium target.
• –so- means bone is targeted.
• –ci- targets circulation.
• –fu- targets fungus.
• –gro- targets growth factor.
• –ki- or –li- which means it is interleukin or immune targeted.

Adverse events

• Decreased cellular immunity which an cause reactivation or new
  • Tuberculosis
  • Sepsis
  • Fungal infections
  • Hepatitis B
• Neurologic syndromes
  • Multiple sclerosis
  • Seizures
  • Guillain-Barre syndrome
• Hematologic side effects
  • Aplastic anemia
  • Pancytopenia
• Cardiac effects
  • Congestive heart failure
  • Arrhythmias
• Allergic reactions
• Pulmonary
  • Pneumonia
  • Pneumocystis jirovecii pneumonia
  • Pneumonitis
• Endocrine
  • Thyroiditis
• GI
  • Perforations
  • Clostridium difficile
  • Acute bacterial infections
• Malignancies
  • Non-melanoma skin cancers
  • Lymphoma

Special considerations

• No live vaccines should be given to these patients.