Drug | Safety monitoring tests |
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Methotrexate | |
At 3 weeks, 6 weeks, 12 weeks, then every 3-6 months | Basic blood count with platelets + differential count, ALT |
Every 6 months | Creatinine (in case of impaired renal function, dose reduction) |
Hydroxychloroquine | |
No laboratory monitoring needed. Checkup by an ophthalmologist after 5 years of use |
Sulfasalazine | |
At 3 weeks, 6 weeks, 12 weeks, then every 3-6 months | Basic blood count with platelets + differential count, ALT |
Leflunomide | |
At 3 weeks, 6 weeks, 12 weeks, then every 3-6 months | Basic blood count with platelets + differential count, ALT, blood pressure |
Note the long biological half-life. Should severe adverse effects occur, treatment should be interrupted and elimination of the drug from the body started (cholestyramine or medicinal charcoal) |
Azathioprine | |
At 3 weeks, 6 weeks, 12 weeks, then every 3-6 months | Basic blood count with platelets + differential count, ALT |
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Mycophenolate | |
At 3 weeks, 6 weeks, 12 weeks, then every 3-6 months | Basic blood count with platelets + differential count, ALT |
Ciclosporin | |
At 3 weeks, 6 weeks, 12 weeks, then every 3-6 months | Cretinine, blood pressure |
Biological antirheumatic drugs and JAK inhibitors |
Often used concomitantly with methotrexate in which case monitoring protocol as for methotrexate, and additionally: |
| | Adalimumab, etanercept, golimumab, certolizumab |
| | 1 month after initiation | Basic blood count with platelets (+ differential count) |
| | Infliximab |
| | Before infusion, as considered appropriate by the physician | Basic blood count with platelets (+ differential count), ALT, CRP |
| | Abatacept |
| | 1 month after initiation | Basic blood count with platelets (+ differential count), ALT |
| | Tosilizumab and sarilumab |
| | 1 month after initiation | Basic blood count with platelets (+ differential count), ALT |
| | At 3 months | Lipid levels |
| | Rituximab |
| | Before infusion | Tests used locally, and IgG monitoring |
| | Tofacitinib and baricitinib |
| | At 3 weeks, 6 weeks, 12 weeks, then every 3-6 months | Basic blood count with platelets + differential count, ALT |
| | At 3 months | Lipid levels |
All drugs |
Monitoring tests should also be performed 2-3 weeks after any increase in drug dose. |