Biologics and Immunomodulators

Patients on immunomodulators and biologics require vigilant monitoring due to potential side effects, the effectiveness of treatment, and signs of infections or other complications. Here’s an outline of what doctors should consider when monitoring these patients:

  1. Effectiveness of Treatment:
    1. Symptom relief: Monitor for reduction or resolution of the symptoms related to the condition being treated.
    2. Objective measures: Track lab tests, imaging studies, or other diagnostic evaluations relevant to the condition.
  2. Drug Interactions:
    1. Check interactions with other prescription medications.
    2. Over-the-counter medications and supplements.
  3. Screening Tests:
    1. Tuberculosis (TB): Screen for latent TB before starting certain biologics.
    2. Hepatitis: Screen for hepatitis B and C for specific biologics, as reactivation can occur.
  4. Potential Side Effects:
    1. Gastrointestinal effects: Look for symptoms like nausea, vomiting, diarrhea, or abdominal pain.
    2. Liver function: Check for elevated liver enzymes or signs of liver injury. Regular liver function tests may be indicated.
    3. Bone marrow suppression: Monitor for anemia, leukopenia, or thrombocytopenia. Regular complete blood counts (CBC) can be useful.
    4. Skin reactions: Watch for rashes, alopecia, skin cancer or other skin abnormalities.
    5. Respiratory: Persistent cough, shortness of breath, or interstitial lung disease.
    6. Kidney function: Monitor for proteinuria or elevated creatinine. Periodic checks of renal function may be warranted.
    7. Neurological symptoms: Be vigilant about headaches, dizziness, or peripheral neuropathy.
    8. Injection site reactions (for biologics): Redness, itching, or swelling at the injection site.
    9. Heart function: Some biologics might have cardiovascular implications.
    10. Metabolic changes: Electrolyte imbalances, lipid changes, or altered glucose metabolism.
    11. Demyelinating diseases: Some biologics have been associated with the onset or exacerbation of diseases like multiple sclerosis.
  5. Signs of Infections:
    1. General symptoms: Fever, chills, unusual fatigue, or malaise.
    2. Respiratory: Persistent cough, sore throat, or shortness of breath.
    3. Urinary: Symptoms like burning during urination, increased frequency, or urgency.
    4. Skin: Infections, abscess formation, or slow-healing wounds.
    5. Neurological: Symptoms like persistent headache or stiff neck, which might indicate infections like meningitis.
    6. Lymphadenopathy: Swollen lymph nodes.
  6. Vaccination Status:
    1. Ensure patients are updated with recommended vaccines.
    2. Advise against live vaccines during treatment unless specifically indicated.
  7. Regular Health Metrics:
    1. Blood pressure.
    2. Lipid profile.
    3. Blood glucose.
  8. Patient Adherence and Education:
    1. Ensure the patient is compliant with medications.
    2. Educate patients about potential side effects, the importance of regular follow-up, and reporting any unusual symptoms.
    3. Contraception counseling for drugs with potential teratogenic effects.