Time–concentration profile of serum etanercept in Japanese patients with rheumatoid arthritis after treatment discontinuation before orthopedic surgery

Excerpt

The treatment strategy for rheumatoid arthritis (RA) has changed dramatically over the past decade with the introduction of biologic agents [1]. In Japan, three inhibitors of tumor necrosis factor-alpha (TNFα), infliximab, etanercept, and adalimumab, and the anti-interleukin (IL)-6 receptor antibody tocilizumab are available as new treatment options for RA. Surgical-site infections (SSIs) are the major concern in orthopedic surgery for RA patients treated with biologic agents [2]. Most national guidelines suggest withholding biologic agents before surgery and restarting them postoperatively if there is no evidence of infection and delayed wound healing. In general, it was accepted that orthopedic surgery could be carried out relatively safely in the middle of the 8-week interval in which infliximab was administered at 3 mg/kg [3]. However, perioperative management in patients using etanercept has not reached a general consensus because of the lack of information about the pharmacokinetics of the serum concentration of etanercept after treatment discontinuation in patients with RA. …