Drug Interaction Report

GENERALLY AVOID: Coadministration of interleukin-6 (IL-6) inhibitors with other biologic disease-modifying antirheumatic drugs (DMARDs) may result in increased immunosuppression and a greater risk of infection. Treatment with IL-6 inhibitors has been associated with serious, potentially life-threatening and fatal infections, including tuberculosis, invasive fungal infections such as candidiasis, aspergillosis and pneumocystis, and other opportunistic infections. Cases have occurred mostly in patients receiving concomitant immunosuppressants like methotrexate or corticosteroids. Use of IL-6 inhibitors in combination with biologic DMARDs such as tumor necrosis factor (TNF) blockers, IL-1R antagonists, anti-CD20 monoclonal antibodies, or T-cell costimulation modulators has not been studied. There may be an increased risk of neutropenia and infections during treatment with IL-6 inhibitors in patients who were previously exposed to TNF antagonists.

MANAGEMENT: Concomitant use of IL-6 inhibitors with other biologic DMARDs should be avoided.