Monitoring immune-modulating drugs used in dermatology

Author: A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, February 2016.

Introduction

Refer to standard texts and local approved datasheets for detailed pharmacology and therapeutics about the immune-modulating drugs discussed here.

Second-line drugs commonly used in dermatology (on- or off-label) include:

These are prescribed by specialists, but other health professionals may be involved in the patient’s care. They should be aware at least of indications, contraindications, adverse effects and monitoring requirements.

Indications for immune-modulating drugs

Immune modulating drugs are used for diverse chronic inflammatory skin diseases that are not adequately controlled in other ways. The skin disease should be severe or have a severe functional or psychosocial impact on the patient.

Examples of suitable conditions

Pre-treatment evaluation

The patient is assessed to determine:

Contraindications to treatment

Pregnancy and breastfeeding

Recent vaccination with live vaccine

Non-immunity to varicella-zoster virus (chickenpox, shingles)

Non-responsive disorder

Co-morbidities

Hypersensitivity reactions

Drug interactions are very common with these drugs

Pre-treatment tests

Follow-up visits

Follow-up visits are to determine the efficacy of treatment and any adverse events and to monitor safety.

Adverse events

The possible adverse events from drugs are numerous. Common ones are listed here. They may require reduction in dose or stopping treatment.

Methotrexate

Methotrexate:

Azathioprine

Azathioprine:

Ciclosporin

Ciclosporin:

Biologics

Biologics

Safety monitoring

People on long-term treatment with immune modulating drugs should undergo full body examination in case of skin cancer.

Related information

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