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

Dosing Recommendations

Infliximab is administered as an IV infusion. Depending on the indication, a dose of 3 mg/kg (for rheumatoid arthritis) or 5 mg/kg (for other disease states) is given over a minimum of 2 hours. Therapy is initiated with infusions at 0, 2, and 6 weeks, followed by a maintenance dose every 8 weeks. The dose or frequency of administration may be adjusted for patients who fail to respond to therapy.[3,6]

Etanercept is administered subcutaneously at a dose of 50 mg weekly in adults and 0.8 mg/kg in children, up to a maximum of 50 mg. In adults with plaque psoriasis, a 50 mg dose is given twice weekly for three months as an induction, followed by a reduction to the standard 50 mg weekly dose. In patients unable to tolerate injection of the entire 50 mg dose, the dose may be split and given as two injections on the same day or up to 4 days apart. Instructions for administering the injections are available in the prescribing information, on the manufacturer's website, or by calling the manufacturer's support line at 1-888-436-2735.[4,7]

In adolescents and adults, adalimumab is typically initiated at a dose of 40 mg administered subcutaneously every other week. For patients who do not respond, the frequency may be increased to every week. In patients with Crohn's disease, therapy should be initiated with a 160 mg dose, followed a week later by an 80 mg dose, then two weeks later with a maintenance dose of 40 mg every other week. The larger initial doses for patients with Crohn's disease may be divided into four separate injections to improve patient comfort.[5,8] Children with uveitis have been successfully treated with adalimumab doses ranging from 20 to 40 mg administered every week or every other week.[14]

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