Chapter 47: Biologic Response–Modifying and Antirheumatic Drugs

Hematopoietic drugs such as epoetin alfa, filgrastim, and sargramostim stimulate bone marrow recovery and blood cell production in patients receiving chemotherapy or undergoing bone marrow transplantation. Interferons, classified as alfa, beta, and gamma subtypes, function as recombinant proteins with antiviral, antitumor, and immunoregulatory properties used in hepatitis C, multiple sclerosis, and malignancies. Monoclonal antibodies including rituximab, infliximab, adalimumab, trastuzumab, and bevacizumab target specific cell surface antigens to interrupt cancer cell growth and autoimmune processes, though they carry significant risks of opportunistic infections and black box warnings requiring careful monitoring. Interleukin-based therapies and cytokine receptor antagonists such as aldesleukin, anakinra, tocilizumab, and secukinumab regulate inflammatory cytokine signaling but present complications including capillary leak syndrome and systemic effects. The chapter then addresses rheumatoid arthritis pathophysiology and progressive treatment strategies, beginning with nonsteroidal anti-inflammatory drugs and corticosteroids, advancing to nonbiologic disease-modifying antirheumatic drugs including methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine, and incorporating biologic DMARDs such as etanercept, abatacept, and tyrosine kinase inhibitors that slow disease progression. Nursing considerations encompass comprehensive assessment of allergies and comorbidities, laboratory value monitoring, infection risk stratification, evaluation of contraindications, adverse effect recognition, patient education regarding black box warnings, safe drug administration techniques, and lifestyle modifications to optimize therapeutic outcomes while minimizing treatment-related harm.