Journal Club
Open Access Article

Chemotherapy and Biotherapeutic Agents for Autoimmune Diseases

Eric Zack

biotherapy, chemotherapy
CJON 2012, 16(4), E125-E132. DOI: 10.1188/12.CJON.E125-E132

New trends have emerged in treating patients with autoimmune diseases with medications traditionally used in oncology. This article will summarize a comprehensive literature review performed to identify effective chemotherapy and biotherapeutic agents for treating each of the main autoimmune subtypes (nervous, gastrointestinal, blood and blood vessel, skin, endocrine, and musculoskeletal systems). In addition to agents currently used, some of the newer therapeutic options show great promise to radically improve treatment choices when considering individualized plans. Improved outcomes and symptom management using newer nontraditional therapies provide a great impetus for oncology and nononcology healthcare professionals to remain abreast of the advancements made to current treatment options. All nurses (oncology and nononcology) need to be aware of these new trends and strengthen their understanding of certain oncology medications and their side effects, as well as establish the safe-handling practices necessary to administer these agents. The Oncology Nursing Society's Treatment Basics Course is one option that can provide nononcology nurses with the knowledge needed to fulfill new practice gaps. In addition, oncology nurses need to be aware of the many autoimmune diseases that may be treated with chemotherapy or biotherapy.

Jump to a section

    References

    American Autoimmune Related Diseases Association. (2000a). More women contract disease [Press release]. Retrieved from http://www.aarda.org/press_release8.htm
    American Autoimmune Related Diseases Association. (2000b). New U. S. priorities for women's health research catapult autoimmune disease to forefront, according to new NIH report [Press release]. Retrieved from http://www.aarda.org/women_and_autoimmunity.php
    American Autoimmune Related Diseases Association. (2012). Autoimmune statistics: Autoimmune disease fact sheet. Retrieved from http://www.aarda.org/autoimmune_statistics.php
    American Society of Health-System Pharmacists. (2006). ASHP guidelines on handling hazardous drugs. American Journal of Health-System Pharmacy, 63, 1172-1191. doi:10.2146/ajhp050529
    Bates, D. (2011). Treatment effects of immunomodulatory therapies at different stages of multiple sclerosis in short-term trials. Neurology, 76(1, Suppl. 1), S14-S25. doi:10.1212/WNL.0b013e3182050388
    Bielekova, B., & Becker, B. L. (2010). Monoclonal antibodies in MS: Mechanisms of action. Neurology, 74(Suppl. 1), S31-S40. doi:10.1212/WNL.0b013e3181c97ed3
    Colombel, J. F., Sandborn, W. J., Reinisch, W., Mantzaris, G. J., Kornbluth, A., Rachmilewitz, D., … Rutgeerts, P. (2010). Infliximab, azathioprine, or combination therapy for Crohn's disease. New England Journal of Medicine, 362, 1383-1395. doi:10.1056/NEJMoa0904492
    DeZern, A. E., Petri, M., Drachman, D. B., Kerr, D., Hammond, E. R., Kowalski, J., … Brodsky, R. A. (2011). High-dose cyclophosphamide without stem cell rescue in 207 patients with aplastic anemia and other autoimmune diseases. Medicine, 90(2), 89-98. doi:10.1097/MD.0b013e318210e685
    Efthimiou, P., & Markenson, J. A. (2005). Role of biological agents in immune-mediated inflammatory diseases. Southern Medical Journal, 98, 192-204. doi:10.1097/01.SMJ.0000153119.37032.8B
    El Fassi, D., Nielsen, C. H., Bonnema, S. J., Hasselbalch, H. C., & Hegedüs, L. (2007). B lymphocyte depletion with the monoclonal antibody rituximab in Graves' disease: A controlled pilot study. Journal of Clinical Endocrinology and Metabolism, 92, 1769-1772. doi:10.1210/jc.2006-2388
    Ghezzi, A., Pozzilli, C., Grimaldi, L. M., Brescia Morra, V., Bortolon, F., Capra, R., … Comi, G. (2010). Safety and efficacy of natalizumab in children with multiple sclerosis. Neurology, 75, 912-917. doi:10.1212/WNL.0b013e3181f11daf
    Gladstone, D. E., Zamkoff, K. W., Krupp, L., Peyster, R., Sibony, P., Christodoulou, C., … Coyle, P. K. (2006). High-dose cyclophosphamide for moderate to severe refractory multiple sclerosis. Archives of Neurology, 63, 1388-1393. doi:10.1001/archneur.63.10.noc60076
    Gómez-Almaguer, D., Solano-Genesta, M., Tarín-Arzaga, L., Herrera-Garza, J. L., Cantú-Rodríguez, O. G., Gutiérrez-Aguirre, C. H., & Jaime-Pérez, J. C. (2010). Low-dose rituximab and alemtuzumab combination therapy for patients with steroid-refractory autoimmune cytopenias. Blood, 116, 4783-4785. doi:10.1182/blood-2010-06-291831
    Griffiths, C. E., Strober, B. E., van de Kerkhof, P., Ho, V., Fidelus-Gort, R., Yeilding, N., … Menter, A. (2010). Comparison of ustekinumab and etanercept for moderate-to-severe psoriasis. New England Journal of Medicine, 362, 118-128. doi:10.1056/NEJMoa0810652
    Kaplan, A. P., Joseph, K., Maykut, R. J., Geba, G. P., & Zeldin, R. K. (2008). Treatment of chronic autoimmune urticaria with omalizumab. Journal of Allergy and Clinical Immunology, 122, 569-573. doi:10.1016/j.jaci.2008.07.006
    Knol Publishing. (2011). Monoclonal antibody (Anti CD3) for type I diabetes: Cure or hype? Retrieved from http://teplizumab.wordpress.com/2012/02/24/review
    Kumar, S., Benseler, S. M., Kirby-Allen, M., & Silverman, E. D. (2009). B-cell depletion for autoimmune thrombocytopenia and autoimmune hemolytic anemia in pediatric systemic lupus erythematosus. Pediatrics, 123(1), e159-e163. doi:10.1542/peds.2008-2361
    Kuntzer, T., Carota, A., Novy, J., Cavassini, M., & Du Pasquier, R. (2011). Rituximab is successful in an HIV-positive patient with MuSK myasthenia gravis. Neurology, 76, 757-758. doi:10.1212/WNL.0b013e31820d6290
    Luk, J. M., & Wong, K. F. (2006). Monoclonal antibodies as targeting and therapeutic agents: Prospects for liver transplantation, hepatitis and hepatocellular carcinoma. Clinical and Experimental Pharmacology and Physiology, 33(5-6), 482-488. doi:10.1111/j.1440-1681.2006.04396.x
    Maini, R., St. Clair, E. W., Breedveld, F., Furst, D., Kalden, J., Weisman, M., … Lipsky, P. (1999). Infliximab (chimeric anti-tumour necrosis factor alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. Lancet, 354, 1932-1939.
    Makhani, N., Gorman, M. P., Branson, H. M., Stazzone, L., Banwell, B. L., & Chitnis, T. (2009). Cyclophosphamide therapy in pediatric multiple sclerosis. Neurology, 72, 2076-2082. doi:10.1212/WNL.0b013e3181a8164c
    Miloh, T., Manwani, D., Morotti, R., Sukru, E., Shneider, B., & Kerkar, N. (2007). Giant cell hepatitis and autoimmune hemolytic anemia successfully treated with rituximab. Journal of Pediatric Gastroenterology and Nutrition, 44, 634-636.
    MS ActiveSource. (2011). Types of MS. Retrieved from http://www.msactivesource.com/types-of-ms.xml
    Naismith, R. T., Piccio, L., Lyons, J. A., Lauber, J., Tutlam, N. T., Parks, B. J., … Cross, A. H. (2010). Rituximab add-on therapy for breakthrough relapsing multiple sclerosis: A 52-week phase II trial. Neurology, 74, 1860-1867. doi:10.1212/WNL.0b013e3181e24373
    National Institute of Occupational Safety and Health. (2004). Preventing occupational exposure to antineoplastic and other hazardous drugs in health care settings. Retrieved from http://www.cdc.gov/niosh/docs/2004-165
    National Institutes of Arthritis and Musculoskeletal and Skin Diseases. (2006). Lupus: A patient care guide for nurses and other health professionals (3rd ed.). Retrieved from http://www.niams.nih.gov/health_info/lupus/lupus_guide/lupus_guide.pdf
    National Multiple Sclerosis Society. (2008). Expert opinion paper: Recommendations regarding corticosteroids in the management of multiple sclerosis. Retrieved from http://www.nationalmssociety.org/download.aspx?id=553
    Occupational Safety and Health Administration. (1995). Controlling occupational exposure to hazardous drugs: OSHA technical manual [Electronic version]. Retrieved from http://www.cdc.gov/niosh/topics/antineoplastic/pubs/html
    Oncology Nursing Society. (2010). ONS treatment basics: Antineoplastic therapy in the non-oncology setting. Pittsburgh, PA: Author.
    Petek-Balci, B., Yayla, V., & Ozer, F. (2005). Multiple sclerosis and Hashimoto thyroiditis: Two cases. Neurologist, 11, 301-304. doi:10.1097/01.nrl.0000162956.40653.38
    Ramos-Casals, M., Brito-Zerón, P., Muñoz, S., & Soto, M. J. (2008). A systematic review of the off-label use of biological therapies in systemic autoimmune diseases. Medicine, 87, 345-364. doi:10.1097/MD.0b013e318190f170
    Rovelli, A., Corti, P., Beretta, C., Bovo, G., Conter, V., & Mieli-Vergani, G. (2007). Alemtuzumab for giant cell hepatitis with autoimmune hemolytic anemia. Journal of Pediatric Gastroenterology and Nutrition, 45, 596-599. doi:10.1097/MPG.0b013e318033169f
    St. Clair, E. W., van der Heijde, D. M., Smolen, J. S., Maini, R. N., Bathon, J. M., Emery, P., … Baker, D. (2004). Combination of infliximab and methotrexate therapy for early rheumatoid arthritis: A randomized, controlled trial. Arthritis and Rheumatism, 50, 3432-3443.
    U. S. Department of Energy Genome Program's Biological and Environmental Research Information System. (2011). Human genome project information. Retrieved from http://www.ornl.gov/sci/techresources/Human_Genome/home.shtml
    Vizcarra, C., & Belcher, D. (2006). Management of the patient receiving parenteral biologic therapy. Journal of Infusion Nursing, 29, 63-71. doi:10.1097/00129804-200603000-00003
    Zaja, F., Baccarani, M., Mazza, P., Bocchia, M., Gugliotta, L., Zaccaria, A., … Fanin, R. (2010). Dexamethasone plus rituximab yields higher sustained response rates than dexamethasone monotherapy in adults with primary immune thrombocytopenia. Blood, 115, 2755-2762. doi:10.1182/blood-2009-07-229815