Immunosuppressants - Lymphocyte-signalling inhibitors

Question 1

Biological DMARDs can be used to treat patients in rheumatology. When should biological DMARDs be used?

1 - failure to achieve remission or low disease severity in 3-6 months followingmethotrexateor other conventional DMARD therapy with max, non-toxic range
2 - chronic use of glucocorticoid alongside a DMARD with a dose of 5mg/day ofprednisoneor equivalent to achieve or maintain remission
3 - multiple courses of treatment with glucocorticoids
4 - continued progression of erosive disease or structural damage that is not accounted for by prior joint damage
5 - all of the above

Answer 1

5 - all of the above

It can be any of these and does not need to be all of them

Question 2

What does mab relate to at the end of a drug name?

1 - indicates a chimeric mAb
2 -indicates a monoclonal antibody
3 - indicates a humanized
4 - indicates a fully human mAb

Answer 2

2 -indicates a monoclonal antibody

B cells are immortalised and selected to create clones capable of producing homogenous antibodies against specific epitopes of target proteins

They are adapted to ensure they are not immunogenic in humans

Question 3

What does ximab relate to at the end of a drug name?

1 - indicates a chimeric mAb
2 -indicates a monoclonal antibody
3 - indicates a humanized mAb
4 - indicates a fully human mAb

Answer 3

1 - indicates a chimeric mAb

Question 4

What does zumab relate to at the end of a drug name?

1 - indicates a chimeric mAb
2 -indicates a monoclonal antibody
3 - indicates a fully human mAb
4 - indicates a humanized

Answer 4

4 - indicates a humanized mAb

Question 5

What does umab relate to at the end of a drug name?

1 - indicates a chimeric mAb
2 -indicates a monoclonal antibody
3 - indicates a fully human mAb
4 - indicates a humanized mAb

Answer 5

3 - indicates a fully human mAb

Question 6

Which of the following are the core Lymphocyte-signaling inhibitor we need to be aware of?

1 - Infliximab
2 - Ciclosporin
3 - Adalimumab
4 - Omalizumab

Answer 6

2 - Ciclosporin

Inhibits transcription of proteins and reduces lymphocytic (WBCs) signalling

Also acts as a calcineurin inhibitor that inhibits T cell activation

Question 7

What is one core adverse event that are caused by ALL monoclonal antibodies?

1 - seizures
2 - immediate/delayed hypersensitivity
3 - leukopenia
4 - hearing loss

Answer 7

2 - immediate/delayed hypersensitivity

Includes urticaria, fever, systemic symptoms and even anaphylaxis

Drugs are typically monitored for 1h after administration and monitored after this

Question 8

All of the following are adverse effects of Ciclosporin, which is the most common?

1 - eye inflammation
2 - GI upset
3 - appetite suppression
4 - fatigue

Answer 8

1 - eye inflammation

Question 9

Which of the following is NOT an indication for the use of Ciclosporin according to the BNF?

1 - severe RA
2 - severe psoriasis
3 - prophylaxis of severe persistent allergic asthma
4 - organ transplantation
5 - severe atopic dermatitis
6 - nephrotic syndrome

Answer 9

3 - prophylaxis of severe persistent allergic asthma

Very strong medication