KINGSTON RHEUMORS
Surgery in the immunosuppressed
The following table offers guidelines on when to stop biologic therapy undergoing surgery.
Clearly the type of surgeryand the patients general health is a consideration.
Evidence to guide this advice is limited and the advice should be considered empirical.
|
|
DRUG |
HALF LIFE |
DOSE |
RECOMMENDATIONS |
| Infliximab (Remicade) |
Median half life is 8-9 days but can be detected in serum for 8 weeks | 3-5mg / Kg every 6-8 weeks | Stop at least for weeks before, and restart 4 weeks after surgery | |
|
Etanercept (Enbrel) |
1 week
|
25 mg twice a week sub cut or 50 mg once weekly |
Stop 2 weeks before and restart 1 week after | |
|
Adalimumab (Humira) |
2 weeks | 40 mg s/c every 2 weeks
|
Stop 2 weeks before and restart 2 weeks after | |
| Golimumab | 1-3 weeks |
50 mg s/c monthly |
Stop 1 month before and restart 2 weeks after |