24 Practical Prescribing of IL-1 Blockers82,83 Pretreatment monitoring checklist Signs/symptoms of active infection Tuberculosis screening (e.g., skin test, interferon-gamma release assay, recent chest X-ray) Hepatitis B and C serologies Human immunodeficiency virus screening (e.g., rapid antigen/antibody test) Immunization history and anticipated vaccination schedule Complete blood count Renal function (for anakinra) Pregnancy status Active malignancy Active treatment with anti-TNF agents, including: { Adalimumab { Certolizumab pegol { Golimumab { Infliximab { Etanercept { Lenalidomide { Pomalidomide Getting access to IL-1 blockers Cost and insurance coverage are major barriers that must be overcome in order to ensure patient access to anakinra and rilonacept. Providers should submit the necessary prior authorization paperwork to ensure timely access. Costsaving options should be employed when possible. Co-pay cards and patient assistance program applications can be found on the respective pharmaceutical company website or through other resources such as NeedyMeds (https:// www.needymeds.org/). If the patient is unable to afford anakinra or rilonacept, despite all attempts to reduce cost, then azathioprine may be considered.1 Patient education checklist Refrigeration storage Preparation, reconstitution (rilonacept) and injection techniques Proper dosing and handling of missed doses Common and serious adverse effects Mitigation of injection site reactions, including: { Bring medication to room temperature before injection { Use cold compress before and after injection { Apply topical corticosteroids or antihistamines to injection site { Consider using oral antihistamines, if needed { Rotate injection sites and avoid bruised or tender areas Signs/symptoms of infection and when to temporarily hold therapy Manage refills and awareness of patient access issues. This includes renewals for prior authorizations or patient assistance programs, and providing any necessary documentation. Kineret. Package insert. Swedish Orphan Biovitrum AB (publ); 2020. Arcalyst. Package insert. Kiniksa Pharmaceuticals; 2021.
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