Monitoring Of Nonsteroidal Immunosuppressive Drugs In Patients With Lung Disease And Lung Transplant Recipients

Publication Date: November 1, 2012
Last Updated: March 14, 2022

Recommendations

Anti-Tumor Necrosis Factor-α Agents

For patients who will undergo anti-TNF-α therapy, a chest radiograph is recommended prior to treatment. (1, C)
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For patients who will undergo anti-TNF- α therapy, a tuberculin skin test is recommended to screen for latent TB prior to treatment. (1, C)
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For patients who will undergo anti-TNF-α therapy and present with a chest x-ray consistent with prior TB or a positive tuberculin skin test and/or are high-risk individuals, active TB infection should be excluded prior to treatment with
  • adalimumab,
(1, C)
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  • etanercept
(1, B)
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  • infliximab.
(1, B)
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For patients with latent M tuberculosis , active prophylactic treatment following published guidelines before initiation of anti-TNF-α therapy is recommended. (1, B)
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For patients with latent M. tuberculosis who will undergo anti-TNF-α therapy, close monitoring for TB is recommended for up to 6 months after discontinuing therapy. (1, C)
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For patients who develop symptoms indicative of TB, prompt evaluation for active disease is recommended. (1, C)
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For patients with known grade III or IV New York Heart Association class heart failure, administration of
  • adalimumab,
(1, C)
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  • etanercept or
(1, C)
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  • and infliximab
(1, B)
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is not recommended.
For patients with a history of congestive heart failure who undergo anti-TNF-α therapy, close observation for congestive heart failure exacerbation is recommended. (1, C)
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For patients with a history of demyelinating disease,
  • administration of etanercept is not recommended,
(1, C)
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  • and administration of adalimumab and infliximab is not suggested.
(2, C)
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For patients with no history of demyelinating disease who undergo anti-TNF-α therapy and experience symptoms or display signs of a demyelinating process, discontinuation of therapy is suggested. (2, C)
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For patients who undergo anti-TNF-α therapy and develop symptoms of a lupus-like disorder, discontinuation of therapy is suggested. (2, C)
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For patients who will undergo anti-TNF-α therapy and who are at risk for viral hepatitis, serologic screening for hepatitis B is recommended prior to treatment. (1, C)
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For patients who have hepatitis B virus infection, anti-TNF-α therapy should not be administered.

(1, C)
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For patients who undergo anti-TNF-α therapy and develop unresolved infections, discontinuation of treatment until the infection is resolved is recommended. (1, B)
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For patients who are pregnant, administration of anti-TNF-α therapy is used only if alternatives are not able to be used. (2, C)
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Overview

Title

Monitoring Of Nonsteroidal Immunosuppressive Drugs In Patients With Lung Disease And Lung Transplant Recipients

Authoring Organization

American College of Chest Physicians