Table 2.
Characteristics, route of administration, dosage, and potential side effects for selected biologic agents
| Generic names | Trade names | Specific target | Route | Dosage | Potential side effects |
|---|---|---|---|---|---|
| TNF inhibitors | |||||
| Infliximab | Remicade | TNF-α | IV | 3–5 mg/kg loading at weeks 0, 2, and 6, then maintenance 3–10 mg/kg every 4–8 weeks; maximal dose 20 mg/kg in children | aSusceptibility to infections, including: reactivation of tuberculosis, histoplasmosis, hepatitis B, and fungal infection; hypersensitivity reactions; demyelinating disease; lupus-like syndrome; malignancy; thromboembolic events; congestive heart failure |
| Adalimumab | Humira | TNF-α | SQ | 40 mg every 1–2 weeks (if bodyweight <30 kg; 20 mg every 2 weeks); loading doses of 80–160 mg are recommended for CD and PsO | |
| Etanercept | Enbrel | TNF-α,-β | SQ | Adults 50 mg weekly (may be given 50 mg twice weekly for first 3 months for PsO); children 0.8 mg/kg/week (max 50 mg/week) | |
| Golimumab | Simponi | TNF-α | SQ | 50 mg SQ monthly; except for UC 200 mg at week 0, 100 mg at week 2, then 100 mg every 4 weeks | |
| Certolizumab | Cimzia | TNF-α | SQ | 400 mg SQ at weeks 0, 2, and 4, then 200 mg every 2 weeks or 400 mg every 4 weeks | |
| Lymphocyte inhibitors | |||||
| Daclizumab | Zenapax | T-cells (IL-2Rα) | IV, SQ | 1–2 mg/kg every 2 or 4 weeks | Hypersensitivity reactions, headache, and gastrointestinal disturbance |
| Rituximab | Rituxan | B-cells (CD20) | IV | 500 or 1,000 mg at week 0 and 2; may repeat at 6–12 months thereafter (different regimen for hematologic malignancies) | Susceptibility to infections, infusion reactions, gastrointestinal disturbance, cardiovascular events, muscle spasm, and headache |
| Abatacept | Orencia | T-cells (CTLA-4) | IV, SQ | Adult RA 500–1,000 mg IV loading, then 125 mg SQ weekly; JIA 10 mg/kg, max 1,000 mg IV at weeks 0, 2, and 4, then every 4 weeks | Susceptibility to infections, allergic reactions, headache, nausea, and malignancy |
| Basiliximab | Simulect | T-cells (IL-2Rα; CD25) | IV | 40 mg IV at weeks 0, 2, 4, 8, and 12 | Gastrointestinal disturbance, headache, susceptibility to infections, and hypersensitivity reactions |
| Specific receptor antagonists | |||||
| Anakinra | Kineret | IL-1 receptor | SQ | 100 mg SQ daily; children, starting 1–2 mg/kg to max 8 mg/kg daily (dose adjustment for renal insufficiency) | Injection-site reaction, infections, headache, gastrointestinal disturbance, and fever |
| Canakinumab | Ilaris | IL-1β | IV, SQ | Systemic JIA: 4 mg/kg (max 300 mg) SQ every 4 weeks; CAPS, 2–3 mg/kg SQ every 8 weeks (see text) | Susceptibility to infections, headache, nausea, and abdominal pain |
| Gevokizumab | (XOMA 052) | IL-1β | IV, SQ | In experiment | Susceptibility to infections and hypersensitivity reactions |
| Tocilizumab | Actemra | IL-6 receptor | IV | Initial 4 mg/kg IV every 4 weeks, then increase to 8–12 mg/kg every 2–4 weeks | Serious infections, hypersensitivity reactions, and gastrointestinal perforation |
| Alemtuzumab | Campath | CD52 | IV | 30 mg IV, 3 days per week for 12 weeks | Cytopenias, infusion reactions, infections, gastrointestinal disturbance, and insomnia |
| Efalizumab | Raptiva | CD11a | SQ | 0.7 mg/kg first dose, then 1 mg/kg weekly (max 200 mg/dose) | Infections, progressive multifocal leukoencephalopathy, malignancy, arthritis, and thrombocytopenia |
| Interferons | |||||
| Interferon α-2a | Roferon-A | Nonspecific | SQ | 3–6 million units SQ daily, tapering over 6 months | Injection-site reactions, flu-like symptoms, and bone marrow suppression |
Notes:
a
Listed side effects apply to all TNF inhibitors shown in this table. Copyright 2012. Adapted with permission from Retina Today. Pasadhika S, Suhler EB, Cunningham ET. Biologic therapy for posterior uveitis and panuveitis. Retina Today. 2012:74–79.49
Abbreviations: CAPS, cryopyrin-associated periodic syndromes; CD, Crohn’s disease; IL, interleukin; IV, intravenously; JIA, juvenile idiopathic arthritis; PsO, plaque psoriasis; RA, rheumatoid arthritis; SQ, subcutaneously; TNF, tumor necrosis factor; UC, ulcerative colitis.