Clinical Management: Immunology Flashcards

Upadacitinib is best described as which type of agent?

Answer: Selective JAK1 inhibitor

Upadacitinib preferentially inhibits JAK1, but it still carries the class boxed warnings for JAK inhibitors.

A patient with a history of multiple sclerosis is being considered for psoriatic arthritis therapy. Which class warrants the most caution?

Answer: TNF inhibitors

TNF inhibitors have been linked to new or worsening demyelinating disease and should be avoided in MS.

Belimumab is used in systemic lupus erythematosus to inhibit which target?

Answer: B-lymphocyte stimulator (BLyS/BAFF)

Belimumab binds soluble BLyS, which reduces B-cell survival and differentiation.

What is the standard secukinumab dosing for adult plaque psoriasis?

Answer: 300 mg at weeks 0, 1, 2, 3, and 4, then every 4 weeks

Secukinumab is loaded weekly for 5 doses and then given every 4 weeks as maintenance.

A patient is HBsAg-negative and anti-HBc-positive, and is about to start a TNF inhibitor. What is the best approach?

Answer: Monitor HBV DNA and ALT or give antiviral prophylaxis per hepatology guidance

A resolved HBV infection can reactivate under immunosuppression, so monitoring or prophylaxis is recommended.

A Crohn's patient loses response to infliximab maintenance. What is the next evidence-based step?

Answer: Check infliximab trough level and antidrug antibodies

Reactive therapeutic drug monitoring tells apart low exposure (dose escalation), immunogenicity (switch within class), and mechanistic failure (switch class).

Before starting tofacitinib, which vaccine is recommended because of increased infection risk with JAK inhibitors?

Answer: Recombinant zoster vaccine

JAK inhibitors raise the risk of herpes zoster, and the non-live recombinant zoster vaccine is preferred before or during therapy.