Tumor Necrosis Factor Alfa Antagonists for Pediatric Immune-Mediated Diseases

Marcia L. Buck, Pharm.D., FCCP

Pediatr Pharm. 2007;13(8):1-4. 

In This Article

Drug Interactions

The TNFα antagonists should not be administered with anakinra, an interleukin-1 antagonist.[3,4,5,6,7,8] In a 24-week clinical trial, the combination of etanercept and anakinra resulted in a 7% rate of serious infections, compared to 0 in the group receiving etanercept alone. Based on the results of this trial, the combination is not recommended.[7] The use of etanercept with cyclophosphamide has been linked with a higher incidence of solid tumors and is not recommended. Concomitant use of etanercept and sulfasalazine may cause mild neutropenia.[7]

The safety and efficacy of live vaccines have not been studied in patients receiving TNFα antagonists. Because of the potential risk for infection, it is recommended that patients taking these drugs not receive live vaccines. Children should be brought up to date with all immunizations prior to initiating therapy. Patients with a significant varicella exposure should temporarily discontinue therapy. Treatment with varicella immune globulin may be beneficial if infection occurs.[3,4,5,6,7,8]

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