Medication Guides

These pages contain alerts about drug supply changes and streamlined information regarding the administration of biologic, antiresorptive, and other medications used to treat patients with rheumatic disease. Items submitted by members have been provided voluntarily for others to use in their practices. In addition to streamlined information, the Quick Guides also provide a link to the manufacturers’ full prescribing information, patient medication guide, and applicable dosing calculators.

The following guides were developed to assist registered nurses (RNs) and other health professionals new to rheumatology or those in need of basic information about each of the listed agents.

If you are a patient, please consult your rheumatologist or health professional for medical advice, diagnosis, and treatment for your unique medical condition. For more details on how working with a rheumatologist can help you live well with rheumatic disease, read our article on the importance of following your treatment plan.

Administration of In-Office Biologics and Other Rheumatic Agents

Biologics

Pegloticase (Krystexxa) is a pegylated enzyme containing a recombinant form of mammalian uricase enzyme derived from a genetically modified strain of E. coli. Pegloticase lowers uric acid by promoting the oxidation of uric acid to allantoin, which is then renally excreted. Pegloticase was initially approved in the U.S. in 2010.

Abatacept (Orencia) is a biologic response modifier that binds to CD80 and CD86 receptors on the antigen-presenting cell and prevents these receptors from binding to CD28 receptors on T cells, which decrease inflammation by downregulating T cell activation.

Belimumab (Benlysta) is a human monoclonal antibody that binds to soluble B-lymphocyte stimulator (BLyS), inhibiting BLyS. This action inhibits survival of B cells and reduces differentiation of B cells into immunoglobulin-producing plasma cells.

Certolizumab Pegol (Cimzia) is a recombinant, humanized antibody to Fab' fragment, with specificity for human TNF-α, conjugated to an approximately 40kDa polyethylene glycol (PEG2MAL40K).

Infliximab (Remicade) is a chimeric (part mouse, part human) monoclonal antibody that blocks activity of a key biologic response mediator called "tumor necrosis factor (TNF) alpha".

Rituximab (Rituxan) is a genetically engineered chimeric murine/human monoclonal IgG, kappa antibody directed against the CD20 antigen.

Tocilizumab (Actemra) is a recombinant humanized anti-human interleukin-6 (IL-6) receptor monoclonal antibody of the immunoglobulin IgG1κ subclass with a typical H2L2 polypeptide structure.

Golimumab (Simponi Aria) is a biologic reference guide with prescribing information, dosage, medication administration, and possible side effects.

Antiresorptive

Ibandronate (Boniva) is a nitrogen-containing bisphosphonate that inhibits osteoclast-mediated bone resorption.

Denosumab (Prolia) is a human monoclonal antibody to receptor activator of nuclear factor kappa-beta ligand (RANKL). Binding to RANKL inhibits activation of RANK on the surface of osteoclasts and its precursors thereby inhibiting osteoclast formation, maintenance, and survival, leading to decreased bone resorption and remodeling therefore increasing bone mass in both cortical and trabecular bone.

Zoledronic Acid (Reclast) is a bisphosphonate and acts primarily on bone. It is an inhibitor of osteoclast-mediated bone resorption.