Magazine article American Nurse Today

Chemotherapy and Biotherapy Drugs for Autoimmune Disease: New Biotherapy Drugs and Older Chemotherapy Agents May Improve Quality of Life in Patients with Autoimmune Diseases

Magazine article American Nurse Today

Chemotherapy and Biotherapy Drugs for Autoimmune Disease: New Biotherapy Drugs and Older Chemotherapy Agents May Improve Quality of Life in Patients with Autoimmune Diseases

Article excerpt

WHILE REVIEWING the medication list for a new patient with rheumatoid arthritis (RA), you note she has an order for rituximab and methotrexate. A quick search in a nursing drug handbook tells you rituximab is a biotherapy drug indicated for patients with non-Hodgkin's lymphoma, and methotrexate is classified as a chemotherapy drug.

Why are an increasing number of drugs normally given to cancer patients now being used to treat autoimmune diseases? You're not chemotherapy "certified," so you wonder whether you can give these drugs. Do they require special handling precautions?

Autoimmune diseases cause suffering and disability for many persons. New biotherapy drugs and older chemotherapy agents have the potential to ease symptoms and improve quality of life. This article provides the information you need to administer these medications and to teach patients about them.

Understanding autoimmune diseases

Autoimmune diseases occur when the body recognizes its own tissues as foreign and triggers the adaptive (acquired) immune system to attack them. This reaction may occur in only one body system, such as a joint (as in rheumatoid or psoriatic arthritis), or across multiple systems, as in systemic lupus erythematosus (SLE). Autoimmune diseases can cause physical impairment and a decreased quality of life. Although their exact cause remains unknown, experts suspect a combination of factors, such as genetics and the environment, play a role.

The National Institutes of Health estimate that up to 23 million Americans have autoimmune diseases, making them more common than cancer or heart disease. These diseases often are marked by periods of remission alternating with incapacitating exacerbations.

Currently, 80 to 100 autoimmune diseases have been identified, but about 40 other conditions have a suspected autoimmune basis. Besides RA and SLE, common autoimmune diseases include psoriasis, multiple sclerosis (MS), myasthenia gravis, inflammatory bowel disease (Crohn's disease and ulcerative colitis), sarcoidosis, and scleroderma.

How autoimmune diseases are treated

Because no known cure exists, treatment of autoimmune diseases focuses mainly on managing symptoms and achieving remission. Recommendations include lifestyle modifications, such as regular exercise, a well-balanced diet, plenty of sleep, and stress control.

Until recently, pharmacologic treatment was limited to analgesics, nonsteroidal anti-inflammatory drugs, and corticosteroids. But since disease-modifying antirheumatic drugs (DMARDs) were introduced, many patients have experienced better symptom control and improved quality of life. DMARDs essentially are either chemotherapy or biotherapy medications; many traditionally have been used to treat cancer. Their effectiveness against autoimmune diseases is thought to stem from their immunosuppressant or immuno-modulating properties.

Chemotherapy drugs exert their effects on rapidly dividing cells, causing cell death at the point where the cell tries to divide. They suppress the immune system and commonly cause neutropenia (an abnormally low neutrophil count). Although these side effects are undesirable in cancer treatment, they may be exactly what patients with autoimmune diseases need. Immunosuppression has led to use of these drugs in patients with autoimmune diseases, although most haven't been approved by the Food and Drug Administration (FDA) for treating such diseases.

Biotherapy drugs change the relationship between the body and the immune cells--in essence, restoring, augmenting, or modulating the immune system. They either mimic substances normally produced by the body or block other natural substances that are part of the immune system. By interfering with immune reactions, they inhibit key factors that cause immunologic inflammation, such as interferon, tumor necrosis factor, and T-lymphocytes. Thus, they're effective against inflammation--the hallmark of autoimmune diseases. …

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