Infection: Biologic medications increase the risk of serious and opportunistic infections. If the patient has a fever, an infection, or is prescribed antibiotics for an infection the medication should be stopped until the infection has been treated. These medications can increase the risk of rare infections including mycobacterial and fungal infections.
Surgery: Biologics should be stopped prior to surgery as they may increase the risk of infection. The timing of discontinuation depends on the biologic being used. It can be restarted once the surgical wound has healed and there is no sign of infection.
Vaccination: Live vaccines should not be given with biologics. Common live vaccines include:
- Shingles & Varicella
- Yellow Fever & Typhoid
- Measels, Mumps, Rubella (MMR)
- Intra-nasal flu vaccine, NOT ‘flu shot’
Other Important Vaccination Information:
- Vaccination for influenza and pneumococcus: Recommended for patients with RA before or during treatment with traditional and biologic DMARDs. Hepatitis B vaccine should be considered in high-risk groups.
- Inactivated vaccines: Ideally be administered prior to starting treatment with methotrexate and/or biologic DMARD as these medications may attenuate the immune response.
- Live vaccines: Should be administered at least 2 weeks and ideally 4 weeks prior to starting treatment with biologic DMARD. In patients currently receiving biologic therapy, treatment with the biologic should be suspended and the vaccine administered after an appropriate interval based on the pharmacokinetic properties of the agent. Zoster vaccine should be considered in high-risk groups and in RA patients age 60 years or older. Herpes zoster vaccine may be given to patients receiving methotrexate (≤ 25 mg/week) and/or low-dose corticosteroids (< 20 mg per day).
Travel: This medication is a self-administered injection and therefore contains a needle. It is necessary for this product to be carried on board an aircraft during the patient’s travel. My patient is carrying their prescription medications along with disposable needles and syringes.
For more information see the Canadian Rheumatology Association Treatment Recommendations for RA, available at https://rheum.ca.