Etanercept

A review of the records reveals the member to be young male with a birth date of 01/15/1999. The member has a diagnosis of Crohn’s disease. His provider, Reinaldo Garcia-Naveiro, M.D. recommended Prometheus Anser IFX diagnostic testing that was performed on 12/15/14. The carrier has denied coverage of Prometheus Anser IFX testing as investigational. There is a letter to Nancy Twigg from the carrier dated 11/24/15. In the letter, the carrier states in part: “The submitted medical records were reviewed. In accordance with the Medical Mutual Corporate Medical Policy 201303 for Genetic Testing and Genetic Counseling General Policy, it was determined that the Prometheus Anser IFX is investigational. This test has insufficient evidence for improved outcomes.” Discussion: The member is a 17 year old with a history of Crohn’s disease with active symptoms of non-bloody diarrhea, with 4 loose stools/day, fatigue and growth failure without abdominal pain or peripheral manifestations of IBD (Irritable Bowel Disease). He has been managed on Remicade, methotrexate, iron and folic acid. A colonoscopy found active inflammation at the IC valve and concern of possible secondary failure led to Prometheus Anser IFX trough level testing on 11/04/2014. The levels returned ruling out anti drug antibodies and found IFX in detectable levels By way of background, the Prometheus® Anser™ IFX assay is a proprietary test that measures both serum infliximab levels and antibodies to infliximab,…

after the final dose.) The recombinant vaccine also demonstrated high protective efficacy in a variety of high risk populations, including neonates born to mothers that were carriers of hepatitis B. Recombinant hepatitis B has a tolerability profile similar to other hepatitis B vaccines, and it has a high level of protective efficacy. The recombinant vaccine is also promising because it offers flexibility in dosing schedules, and appeared to confer immunity for at least ten years (Keating &…

abilities to activate complement are important aspects to understand different drugs relating to autoimmune diseases. Each of the four drugs, infliximab, Adalimumab, Etanercept, and Certilizumab, have different antibody structures, leading to differences in function and binding abilities. The drug infliximab is a chimeric monoclonal antibody, containing 25% mouse-derived and 75% human-derived amino acids. The drug Adalimumab is a fully human monoclonal antibody containing an IgG1 antibody,…

Etanercept is taken for varying forms of arthritis. It is a TNF blocker, and works by blocking protein (TNF-alpha) that causes inflammation. However, its side effects include the weakening of the immune system, which can cause autoimmune diseases. Adalimumab treats various inflammatory conditions including, Rheumatoid Arthritis, Juvenile Idiopathic Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis, etc. If you are taking a TNF blocker (like Etanercept) you can develop cancers like…

deformities" of the digits, and deformities of the Distal interphalangeal joints of fingers and toes involved with psoriatic nail changes. Typically, skin lesions are associated with psoriasis. Sometimes proliferative synovitis of the wrists and fingers occur, resembling rheumatoid arthritis. In these cases, x-rays and laboratory testing help to differentiate the two diseases. Treatment for both conditions are similar, using anti-inflammatory agents, anti-malarials, and adding methotrexate…

Results Of 11,996 articles, 15 articles were reviewed for this systematic review that were relevant to clinical research topic. The results from the articles were used to address the question which treatment immunosuppressives or corticosteroids is better in treating adolescents with systemic lupus erythematosus. Immunosuppressives reviewed in this paper are Hydroxychloroquine, Methotrexate, Cyclophosphamide, Rituximab, Azathioprine, Mycophenolate Mofetil, Anti-cytokines (including anti-TNF…

Important parameters required for systemic treatment: Severity of psoriasis (PASI), life quality (DLQI), presence of psoriatic arthritis, pregnancy, man attempting to conceive a child, history of hematologic malignancy, immunodeficiency, alcohol use. Baseline laboratory workup before systemic treatment include comprehensive metabolic panel, complete blood count. Additionally, β-human chorionic gonadotropin, lipid panel, hepatitis markers (hepatitis B and C) and PPD or quantiferon test should be…

decision-making from the start. The specific treatment varies according to the location, severity, clinical variants and duration of the disease. Topical agents such as vitamin D analogues, corticosteroids, tacrolimus, pimecrolimus, tazarotene, anthralin, coal tar and salicyclic acid have all demonstrated efficacy in the treatment of psoriasis. Special attention should be given to the duration and dose of topical corticosteroids due to the risk of local and systemic side effects. The most…

Abstract Psoriasis is a chronic auto – immune disease that is believed to be inherited and most common in women. There are seven types of Psoriasis (Plaque Psoriasis, Guttate Psoriasis, Inverse Psoriasis, Pustular Psoriasis, Erythrodemic Psoriasis, Nail Psoriasis and Psoriatic Arthritis), but the most common is Plaque Psoriasis and it affects 4 million people in the United States. It is characterized by raised, inflamed, patchy, red skin covered with white scales that is cause by an excess of…

medically necessary. CIGNA’s approval criteria require combined methotrexate with Remicade. Based on review of the submitted medical records from January 2011 – December 2015, the member was observed to have an inflammatory polyarthritis. The addition of an NSAID plus Medrol failed to allow a reduction of steroid dosing so in December 2012 methotrexate was started and the dose was escalated over the next 4 months. In April 2013, she still required 3mg Medrol daily to control synovitis. In…