Certolizumab Pegol

INTRODUCTION

Indications

Moderate-to-severe active Crohn's disease when response to conventional therapy has been inadequate.

Action

Neutralizes tumor necrosis factor (TNF), a prime mediator of inflammation; pegylation provides a long duration of action. Therapeutic Effects: Decreased signs/symptoms of Crohn's disease.

Adverse Reactions/Side Effects

Derm: skin reactions (rarely severe). Hemat: hematologic reactions. MS: arthralgia. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYALXIS, INFECTIONS, lupus-like syndrome.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Be alert for signs of systemic infections, especially respiratory infections (fever, chills, cough, mucus production, shortness of breath, wheezing, chest discomfort, fatigue) and GI infections (nausea, vomiting, diarrhea, abdominal pain). Notify physician immediately of these signs.

• Monitor signs of hematologic reactions such as leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, and bleeding gums), or unusual weakness and fatigue that might be due to anemia. Report any suspicious signs of blood disorders.

• Monitor any changes in GI symptoms (decreased abdominal pain, decreased diarrhea, improved appetite) to help document whether drug therapy is successful in managing Crohn's disease.

• Assess any joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Monitor signs of lupus-like syndrome, including increased blood pressure (BP), fever, joint pain, skin rashes, and redness/irritation of the eye (uveitis). Notify physician promptly if these signs appear.

Patient/Client-Related Instruction

• Advise patient to avoid alcohol and foods that may cause an increase in GI irritation.

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged skin reactions (rash, dermatitis).

Pharmacokinetics

Absorption: 80% absorbed following SC administration.

Distribution: Unknown.

Metabolism and Excretion: Unknown.

Half-life: 14 days.

Contraindications/Precautions

Contraindicated in: Active untreated infection; Hepatitis B reactivation.

Use Cautiously in: History of recurrent infections, concurrent immunosuppressants, medical conditions associated with increased risk of infection, current residence in areas where tuberculosis or histoplasmosis are endemic, history of hepatitis B infection (may reactivate); History of demyelinating disorders (may exacerbate); History of heart failure; Geri: May increase risk of infections; OB: Use pregnancy only if clearly ...