DMARDs - Monitoring Overview

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Conventional DMARDs Monitoring Overview

The following provides up-to-date advice on the monitoring requirements for conventional medications used with Rheumatology Homecare Medicines Services. The monitoring schedules are based on the BSR and BHPR Guideline for the Prescription and Monitoring of Non-biologic Disease-Modifying Anti-rheumatic Drugs accredited by NICE.

Drugs and Their Monitoring Requirements and Schedule

AZATHIOPRINE

  • FBC, U&E, LFT every 2 weeks until dose stable for 6 weeks; monthly for 3 months; then every 3 months

CICLOSPORIN (CYCLOSPORIN)

  • FBC, U&E, LFT, Glc, BP every 2 weeks until dose stable for 3 months; then monthly

HYDROXYCHLOROQUINE SULFATE

  • No blood monitoring requirements

LEFLUNOMIDE

  • FBC, U&E, LFT, BP, weight every 2 weeks until dose stable for 6 weeks; monthly for 3 months; then every 3 months

METHOTREXATE

  • FBC, U&E, LFT every 2 weeks until dose stable for 6 weeks; monthly for 3 months; then every 3 months

MYCOPHENOLATE MOFETIL

  • FBC, U&E, LFT every 2 weeks until dose stable for 6 weeks; monthly for 3 months; then every 3 months

PENICILLAMINE

  • FBC, U&E, LFT, urinalysis every 2 weeks until dose stable for 6 weeks; monthly for 3 months; then every 3 months

SULFASALAZINE (SULPHASALAZINE)

  • FBC, U&E, LFT every 2 weeks until dose stable for 6 weeks; monthly for 3 months; then every 3 months until 1year; after 1 year no monitoring required

Biologic DMARDs Monitoring Overview

The following provides up-to-date advice on the monitoring requirements for biologic medications used with Rheumatology Homecare Medicines Services. The monitoring schedules are based on The British Society for Rheumatology Biologic DMARD Safety Guidelines in Inflammatory Arthritis accredited by NICE.

Drugs and Their Monitoring Requirements and Schedule

ABATACEPT

  • FBC, U&Es, LFTs every 6 months

ADALIMUMAB

  • FBC, U&Es, LFTs every 6 months

ANAKINRA

  • FBC monthly for 6 months, then every 3 months

CERTOLIZUMAB

  • FBC, U&Es, LFTs every 6 months

ETANERCEPT

  • FBC, U&Es, LFTs every 6 months

GOLIMUMAB (AS)

  • FBC, U&Es, LFTs every 6 months

IXEKIZUMAB

  • FBC at 3 months, then every 6 months

SARILUMAB

  • Check FBC, LFT, lipids 4-8 weeks then check FBC, LFTs every 3 months and lipids every 6 months

SECUKINUMAB

  • FBC, U&E’s LFTs at 3 months; then every 6 months

TOCILIZUMAB

  • Fasting lipid profile at 4-8 weeks after starting drug
  • FBC, U&E, LFT every 4-8 weeks for first 6 months then every 3 months

USTEKINUMAB

  • FBC, U&E, LFT every 6 months

BARICITINIB

  • Fasting lipid profile 12 weeks after starting drug
  • FBC, U&E, LFTs at 4 weeks, 12 weeks and every 3 to 6 months thereafter

FILGOTINIB

  • Fasting lipid profile 12 weeks after starting drug
  • FBC, U&E, LFTs at 4 weeks, 12 weeks and every 3 to 6 months thereafter

TOFACITINIB

  • Fasting lipid profile 8 weeks after starting drug
  • FBC, U&E, LFTs at 4 weeks, 12 weeks and every 3 months thereafter

UPADACITINIB

  • Fasting lipid profile 12 weeks after starting drug
  • FBC, U&E, LFTs at 4 weeks, 12 weeks and every 3 to 6 months thereafter

Resources/Supporting Evidence:

Holroyd C.R., Seth R.M., Malaviya A., Holmes C., Curtis E., Chan C., Yusuf M.A., Litwic A., Smolen S., Topliffe J., Bennett S., Humphreys J., Green M., Ledingham J. (2019) The British Society for Rheumatology biologic DMARD safety guidelines in inflammatory arthritis. Rheumatology, Volume 58(2), pp. 220-226. DOI: https://doi-org.knowledge.idm.oclc.org/10.1093/rheumatology/key208.

Ledingham J., Gullick N., Irving K., Gorodkin R., Aris M., Burke J., Gordon P., Christidis D., Galloway S., Hayes E., Jeffries A., Mercer S., Mooney J., van Leuven S., Galloway J.; BSR and BHPR Standards, Guidelines and Audit Working Group (2017) BSR and BHPR guideline for the prescription and monitoring of non-biologic disease-modifying anti-rheumatic drugs. Rheumatology, Volume 56(6), pp. 865-868. DOI: https://doi-org.knowledge.idm.oclc.org/10.1093/rheumatology/kew479.

Last reviewed: 16 November 2021

Next review: 16 November 2024

Author(s): Dr Karen Donaldson (lead author), Dr Elizabeth Murphy, Professor Robin Munro, Dr Sanjiv Nandwani, Dr Saira Batool, Dr Georgiana Young (other contributors to documents included in guideline)

Version: V1

Approved By: Dr Karen Donaldson Rheumatology Clinical Lead; Rheumatology Consultants

Reviewer Name(s): Karen Donaldson