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Things to Consider? How Often? What is important to you about arthritis medicines? Side Effects? How Soon? Cost? 2013, Cincinnati Children’s Hospital Medical Center. All Rights Reserved. © This work is taken from or based upon information and data from sites contributing to the Pediatric Rheumatology – Care and Outcomes Improvement Network (PR-COIN) www.pr-coin.org and may not be used for commercial purposes. How Long? Things to Consider? ® Medications require blood test monitoring. Pick another topic Sulfasalazine ® ) (Arava®) While taking these medicines you should... : not become pregnant : not drink alcohol : not receive live vaccines Updated 3.29.13 Avoid these medicines if you... : have liver disease : have TB (you may need to be tested) ) ® Etanercept (Enbrel®) Adalimumab (Humira®) Anakinra (Kineret®) Abatacept (Orencia®) (Remicade®) ® 2013, Cincinnati Children’s Hospital Medical Center. All Rights Reserved. © This work is taken from or based upon information and data from sites contributing to the Pediatric Rheumatology – Care and Outcomes Improvement Network (PR-COIN) www.pr-coin.org and may not be used for commercial purposes. ) Canakinumab (Ilaris®) Tocilizumab (Actemra®) on how often they need to be given. 1x Updated 3.29.13 Sulfasalazine ® ) (Arava®) 2x !"#$% day !"#$% day ) ® 1x ® !"#$% week Etanercept (Enbrel®) How Often? 1-2x !"#$% week !"#$% month Pick another topic 2-4x !"#$% month Abatacept (Orencia®) 1x Adalimumab (Humira®) Anakinra (Kineret®) 1x day (Remicade®) 1x month 2013, Cincinnati Children’s Hospital Medical Center. All Rights Reserved. © This work is taken from or based upon information and data from sites contributing to the Pediatric Rheumatology – Care and Outcomes Improvement Network (PR-COIN) www.pr-coin.org and may not be used for commercial purposes. !"#$% !"#$% ) 1 month every 6 months 1x !"#$% month ® 2x in Canakinumab (Ilaris®) !"#$% Tocilizumab (Actemra®) 1-2x month !"#$% (Arava®) you will experience. Sulfasalazine ® ) ) Side Effects? ® Anakinra (Kineret®) Adalimumab (Humira®) Canakinumab (Ilaris®) Abatacept (Orencia®) Pick another topic • • • • stomach upset diarrhea headache cold symptoms • low blood counts • severe liver injury • • • • mouth sores nausea stomach upset headache • severe skin reaction (Sulfasalazine only) • abnormal liver test • low blood counts • ® Etanercept (Enbrel®) (Remicade®) Uncommon: ) ® • redness or soreness where needle enters skin • common cold • sinus infection • stomach upset • headache • itchy or allergic rash • TB may come back • serious infection that needs antibiotic • low blood counts • development of autoantibodies • • cancers like lymphoma • • • • • TB may come back • serious infection that needs antibiotic • low blood counts • development of autoantibodies • cancers like lymphoma • severe infusion reaction (allergic reaction) common cold sinus or throat infection stomach upset headache Tocilizumab (Actemra®) 2013, Cincinnati Children’s Hospital Medical Center. All Rights Reserved. © This work is taken from or based upon information and data from sites contributing to the Pediatric Rheumatology – Care and Outcomes Improvement Network (PR-COIN) www.pr-coin.org and may not be used for commercial purposes. Updated 3.29.13 There is no way to predict which, if any, Common: In general, these medicines begin to work between 2 and 12 weeks. (Arava®) Sulfasalazine ® ) 4-8 4-12 weeks ® weeks ) ® 4-6 There are ways to manage symptoms until these medicines start working. How Soon? weeks Etanercept (Enbrel®) Adalimumab (Humira®) Anakinra (Kineret®) Canakinumab (Ilaris®) 2-4 2-4 1-3 1-3 weeks weeks Abatacept (Orencia®) (Remicade®) 2-12 2-4 weeks Pick another topic Updated 3.29.13 These medicines do not work right away. weeks 2013, Cincinnati Children’s Hospital Medical Center. All Rights Reserved. © This work is taken from or based upon information and data from sites contributing to the Pediatric Rheumatology – Care and Outcomes Improvement Network (PR-COIN) www.pr-coin.org and may not be used for commercial purposes. weeks ) ® 2-4 weeks weeks Tocilizumab (Actemra®) 2-4 weeks Updated 3.29.13 What you pay will depend on your insurance. Sulfasalazine ® ) (Arava®) $ Patient assistance programs may be available. ® ) ® $ Etanercept (Enbrel®) Adalimumab (Humira®) Anakinra (Kineret®) Canakinumab (Ilaris®) $$ Cost? Abatacept (Orencia®) (Remicade®) ) ® $$$ Pick another topic 2013, Cincinnati Children’s Hospital Medical Center. All Rights Reserved. © This work is taken from or based upon information and data from sites contributing to the Pediatric Rheumatology – Care and Outcomes Improvement Network (PR-COIN) www.pr-coin.org and may not be used for commercial purposes. Tocilizumab (Actemra®) Updated 3.29.13 Stopping or decreasing the medicine may be considered after the disease is well controlled. • • • How often does arthritis remain well controlled after stopping? What are the treatment options if the arthritis comes How Long? • How long has the disease been under control? Pick another topic 2013, Cincinnati Children’s Hospital Medical Center. All Rights Reserved. © This work is taken from or based upon information and data from sites contributing to the Pediatric Rheumatology – Care and Outcomes Improvement Network (PR-COIN) www.pr-coin.org and may not be used for commercial purposes.