Schémas et posologies des traitements ciblés utilisés dans les rhumatismes inflammatoires chroniques

<table><caption>Tableau r&eacute;capitulatif des sch&eacute;mas et posologies des traitements cibl&eacute;s utilis&eacute;s dans les rhumatismes inflammatoires chroniques</caption>
<tbody>
<tr>
<th style="text-align: center;"><strong>&nbsp;</strong></th>
<th style="text-align: center;">
<p><strong>Produit</strong></p>
</th>
<th style="text-align: center;">
<p><strong>Nom</strong></p>
</th>
<th style="text-align: center;">
<p><strong>Voie</strong></p>
</th>
<th style="text-align: center;">
<p><strong>Posologie</strong></p>
</th>
</tr>
<tr>
<td style="text-align: center;" rowspan="6"><br />
<p><strong>Anti-TNF&alpha;</strong></p>
</td>
<td style="text-align: center;" rowspan="2">
<p><span style="font-weight: 400;">Infliximab</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">REMICADE</span><strong>&reg;</strong></p>
<p><span style="font-weight: 400;">INFLECTRA</span><strong>&reg;</strong></p>
<p><span style="font-weight: 400;">REMSIMA</span><strong>&reg;</strong></p>
<p><span style="font-weight: 400;">FLIXABI</span><strong>&reg;</strong></p>
<p><span style="font-weight: 400;">ZESSLY</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">IV</span></p>
</td>
<td style="text-align: left;">
<ul>
<li><span style="font-weight: 400;">Posologies usuelles :</span>
<ul>
<li><span style="font-weight: 400;">PR : 3 mg/kg &agrave; S0, S2, S6, p</span>uis <strong>3 mg/kg/6-8 semaines,</strong></li>
<li>SpA ou rhumatisme psoriasique : 5 mg/kg &agrave; S0, S2, S6, puis <strong>5 mg/kg/6-8 semaines.</strong></li>
</ul>
</li>
<li>Les posologies peuvent &ecirc;tre augment&eacute;es jusqu'&agrave;&nbsp;7,5 mg/kg si n&eacute;cessaire dans la polyarthrite rhumato&iuml;de et la SpA.</li>
</ul>
</td>
</tr>
<tr>
<td style="text-align: center;">
<p><span style="font-weight: 400;">REMSIMA</span><strong>&reg;&nbsp;</strong></p>
<p><span style="font-weight: 400;">(bio-better)</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">SC</span></p>
</td>
<td style="text-align: left;">
<ul>
<li><span style="font-weight: 400;">En relais de la forme IV (</span><span style="font-weight: 400;">4 semaines apr&egrave;s S2 IV ou 8 semaines apr&egrave;s la derni&egrave;re perfusion IV, en entretien) : </span><strong>120 mg/2 semaines&nbsp;</strong><span style="font-weight: 400;">(voire 240 mg/2 semaines).</span></li>
<li><span style="font-weight: 400;">Uniquement pour la PR : possibilit&eacute; de d&eacute;buter directement par voie SC avec dose de charge de 120 mg &agrave; S0, S1, S2, S3, S4 puis 120 mg/2 semaines.<br /></span></li>
</ul>
</td>
</tr>
<tr>
<td style="text-align: center;">
<p><span style="font-weight: 400;">Adalimumab</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">HUMIRA</span><strong>&reg;</strong></p>
<p><span style="font-weight: 400;">A MGEVITA</span><strong>&reg;&nbsp;</strong></p>
<p><strong>IMRALDI</strong><strong>&reg;&nbsp;</strong></p>
<p><span style="font-weight: 400;">IDACIO</span><strong>&reg;</strong></p>
<p><span style="font-weight: 400;">HULIO</span><strong>&reg;</strong></p>
<p><strong>HYRIMOZ&reg;</strong></p>
<p><span style="font-weight: 400;">AMSPARITY</span><span style="font-weight: 400;">&reg;&nbsp;</span></p>
<p><strong>YUFLYMA</strong><strong>&reg;&nbsp;</strong></p>
<p><strong>HUKYNDRA</strong><strong>&reg;&nbsp;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">SC</span></p>
</td>
<td style="text-align: left;">
<p><strong>40 mg/2 semaines&nbsp;</strong><span style="font-weight: 400;">(voire 40 mg/semaine).</span></p>
</td>
</tr>
<tr>
<td style="text-align: center;">
<p><span style="font-weight: 400;">Etanercept</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">ENBREL</span><strong>&reg;&nbsp;</strong></p>
<p><strong>BENEPALI</strong><strong>&reg;</strong></p>
<p><span style="font-weight: 400;">ERELZI</span><strong>&reg;</strong></p>
<p><span style="font-weight: 400;">NEPEXTO</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">SC</span></p>
</td>
<td style="text-align: left;">
<p><strong>50 mg 1 fois par semaine&nbsp;</strong><span style="font-weight: 400;">(ou 25 mg 2 fois par semaine).</span></p>
</td>
</tr>
<tr>
<td style="text-align: center;">
<p><span style="font-weight: 400;">Certolizumab</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">CIMZIA</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">SC</span></p>
</td>
<td style="text-align: left;">
<p><span style="font-weight: 400;">400 mg (2 injections de 200 mg le m&ecirc;me jour) &agrave; S0, S2, S4, p</span>uis <strong>200 mg/2 semaines&nbsp;</strong>(ou 400 mg/mois).</p>
</td>
</tr>
<tr>
<td style="text-align: center;">
<p><span style="font-weight: 400;">Golimumab</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">SIMPONI</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">SC</span></p>
</td>
<td style="text-align: left;">
<p><strong>50 mg/mois&nbsp;</strong><span style="font-weight: 400;">(100 mg/mois si sujet &gt; 100kg).</span></p>
</td>
</tr>
<tr>
<td style="text-align: center;" rowspan="2">
<p><strong>CTLA4-Ig</strong></p>
</td>
<td style="text-align: center;" rowspan="2">
<p><span style="font-weight: 400;">Abatacept</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">ORENCIA</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">IV</span></p>
</td>
<td style="text-align: left;">
<p><span style="font-weight: 400;">S0, S2, S4, p</span><span style="font-weight: 400;">uis </span><strong>toutes les 4 semaines :</strong></p>
<ul>
<li><span style="font-weight: 400;">&lt; 60 kg : 500 mg,</span></li>
<li>60-100 kg : <strong>750 mg,</strong></li>
<li>100 kg : 1000 mg.</li>
</ul>
<p><em><span style="font-weight: 400;">(~ 10 mg/kg/4 semaines)</span></em></p>
</td>
</tr>
<tr>
<td style="text-align: center;">
<p><span style="font-weight: 400;">ORENCIA</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">SC</span></p>
</td>
<td style="text-align: left;">
<p><strong>125 mg/semaine.</strong></p>
</td>
</tr>
<tr>
<td style="text-align: center;" rowspan="3">
<p><strong>anti-IL6R</strong></p>
</td>
<td style="text-align: center;" rowspan="2">
<p><span style="font-weight: 400;">Tocilizumab</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">ROACTEMRA</span><strong>&reg;</strong></p>
<p><span style="font-weight: 400;">TYENNE</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">IV</span></p>
</td>
<td style="text-align: left;">
<p><strong>8 mg/kg/4 semaines</strong></p>
<ul>
<li><span style="font-weight: 400;">si &gt; 100 kg : possibilit&eacute; d&rsquo;aller jusqu&rsquo;&agrave; max 800 mg maximum,</span></li>
<li>si sujet &acirc;g&eacute;, apparition d'une cytolyse h&eacute;patique ou d'une cytop&eacute;nie sous traitement : possibilit&eacute; de baisser &agrave; 4 ou 6 mg/kg.</li>
</ul>
</td>
</tr>
<tr>
<td style="text-align: center;">
<p><span style="font-weight: 400;">ROACTEMRA</span><strong>&reg;</strong></p>
<p><span style="font-weight: 400;">TYENNE</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">SC</span></p>
</td>
<td style="text-align: left;">
<p><strong>162 mg/semaine.</strong></p>
</td>
</tr>
<tr>
<td style="text-align: center;">
<p><span style="font-weight: 400;">Sarilumab</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">KEVZARA</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">SC</span></p>
</td>
<td style="text-align: left;">
<p><strong>200 mg/2 semaine </strong>(diminuer &agrave;&nbsp;<span style="font-weight: 400;">150 mg/2 semaines en cas de cytop&eacute;nie ou de cytolyse h&eacute;patique).</span></p>
</td>
</tr>
<tr>
<td style="text-align: center;" rowspan="2">
<p><strong>anti-CD20</strong></p>
</td>
<td style="text-align: center;" rowspan="2">
<p><span style="font-weight: 400;">Rituximab</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">MABTHERA</span><strong>&reg;</strong></p>
<p><span style="font-weight: 400;">TRUXIMA</span><strong>&reg;</strong></p>
<p><span style="font-weight: 400;">RIXATHON</span><strong>&reg;</strong></p>
<p><span style="font-weight: 400;">RUXIANCE</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">IV</span></p>
</td>
<td style="text-align: left;">
<p><strong>1000 mg &agrave; J1 et J15,</strong><span style="font-weight: 400;">&nbsp;</span><span style="font-weight: 400;">puis 1000 mg/6 mois.</span></p>
</td>
</tr>
<tr>
<td style="text-align: center;">
<p><span style="font-weight: 400;">MABTHERA</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">SC</span></p>
</td>
<td style="text-align: left;">
<p><span style="font-weight: 400;">Pas d&rsquo;AMM pour la PR.</span></p>
</td>
</tr>
<tr>
<td style="text-align: center;" rowspan="4">
<p><strong>JAKi</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">Baricitinib</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">OLUMIANT</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">PO</span></p>
</td>
<td style="text-align: left;">
<p><strong>1 cp de 4 mg/jour &nbsp;</strong>(<span style="font-weight: 400;">2 mg/jour si sujet fragile et absence d'alternative th&eacute;rapeutique : CV, risque de cancer, &gt; 65 ans...).</span></p>
</td>
</tr>
<tr>
<td style="text-align: center;">
<p><span style="font-weight: 400;">Tofacitinib</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">XELJANZ</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">PO</span></p>
</td>
<td style="text-align: left;">
<ul>
<li><strong>1 cp de 5 mg x2 /jour,</strong></li>
<li><strong><span style="font-weight: 400;">Uniquement pour la PR : forme LP 11 mg en une prise par jour &eacute;galement disponible.</span><br /></strong></li>
</ul>
</td>
</tr>
<tr>
<td style="text-align: center;">
<p><span style="font-weight: 400;">Upadacitinib</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">RINVOQ</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">PO</span></p>
</td>
<td style="text-align: left;">
<p><strong>1 cp de 15 mg/jour .</strong></p>
</td>
</tr>
<tr>
<td style="text-align: center;">
<p><span style="font-weight: 400;">Filgotinib</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">JYSELECA</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">PO</span></p>
</td>
<td style="text-align: left;">
<p><strong>1 cp de 200 mg/jour .</strong></p>
</td>
</tr>
<tr>
<td style="text-align: center;" rowspan="2">
<p><strong>Anti-IL 17</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">Secukinumab</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">COSENTYX</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">SC</span></p>
</td>
<td style="text-align: left;">
<ul>
<li><span style="font-weight: 400;">Rhumatisme psoriasique : </span><strong>150 mg ou 300 mg</strong><span style="font-weight: 400;">, une fois par semaine, pendant 5 semaines, p</span>uis <strong>une fois par mois,</strong></li>
<li>SpA : <strong>150 mg</strong>, une fois par semaine, pendant 5 semaines, puis <strong>une fois par mois.</strong></li>
</ul>
</td>
</tr>
<tr>
<td style="text-align: center;">
<p><span style="font-weight: 400;">Ixekizumab</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">TALTZ</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">SC</span></p>
</td>
<td style="text-align: left;">
<p><span style="font-weight: 400;">Rhumatisme psoriasique et SpA : </span><span style="font-weight: 400;">160 mg (2 injections de 80 mg) p</span><span style="font-weight: 400;">uis </span><strong>80 mg tous les mois.</strong></p>
</td>
</tr>
<tr>
<td style="text-align: center;">
<p><strong>Anti-IL 12/23</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">Ustekinumab</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">STELARA</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">SC</span></p>
</td>
<td style="text-align: left;">Rhumatisme psoriasique : 45 mg &agrave; S0, S4, puis <strong>45 mg tous les 3 mois,</strong>(90 mg possible chez le sujet &gt;100 kg).</td>
</tr>
<tr>
<td style="text-align: center;" rowspan="2">
<p><strong>Anti-IL 23</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">Guselkumab</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">TREMFYA</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">SC</span></p>
</td>
<td style="text-align: left;">
<p><span style="font-weight: 400;">Rhumatisme psoriasique : 100 mg &agrave; S0, S4, p</span><span style="font-weight: 400;">uis </span><strong>100 mg tous les 2 mois </strong><span style="font-weight: 400;">(8 semaines).&nbsp;</span><span style="font-weight: 400;">100 mg/4 semaines &eacute;galement possible.</span></p>
</td>
</tr>
<tr>
<td style="text-align: center;">
<p><span style="font-weight: 400;">Risankizumab</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">SKYRIZI</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">SC</span></p>
</td>
<td style="text-align: left;">
<p><span style="font-weight: 400;">Rhumatisme psoriasique : 150 mg &agrave; S0, S4, p</span><span style="font-weight: 400;">uis </span><strong>150 mg tous les 3 mois.</strong></p>
</td>
</tr>
<tr>
<td style="text-align: center;" rowspan="2">
<p><strong>Anti-BAFF/BLyS</strong></p>
</td>
<td style="text-align: center;" rowspan="2">
<p><span style="font-weight: 400;">Belimumab</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">BENLYSTA</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">IV</span></p>
</td>
<td style="text-align: left;">
<p><span style="font-weight: 400;">10 mg/kg &agrave; S0, S2, S4, p</span><span style="font-weight: 400;">uis </span><strong>10 mg/kg toutes les 4 semaines.</strong></p>
</td>
</tr>
<tr>
<td style="text-align: center;">
<p><span style="font-weight: 400;">BENLYSTA</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">SC</span></p>
</td>
<td style="text-align: left;">
<ul>
<li><strong>200 mg/semaine,</strong></li>
<li>2 premi&egrave;res administrations &agrave; effectuer en milieu hospitalier (risque de r&eacute;actions d'hypersensibilit&eacute;).</li>
</ul>
</td>
</tr>
<tr>
<td style="text-align: center;" rowspan="2">
<p><strong>Anti-IL 1</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">Canakinumab&nbsp;</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">ILARIS</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">SC</span></p>
</td>
<td style="text-align: left;">
<ul>
<li><span style="font-weight: 400;">Goutte :</span><strong> 150 mg </strong><span style="font-weight: 400;">toutes les 12 semaines,</span></li>
<li><span style="font-weight: 400;">Arthrite juv&eacute;nile idiopathique, maladie de Still : </span><strong>4 mg/kg</strong><span style="font-weight: 400;"> toutes les 4 semaines.</span></li>
</ul>
</td>
</tr>
<tr>
<td style="text-align: center;">
<p><span style="font-weight: 400;">Anakinra</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">KINERET</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">SC</span></p>
</td>
<td style="text-align: left;">
<p><strong>100 mg/jour</strong>&nbsp;: dur&eacute;e du traitement d&eacute;pendant de l'indication (traitement de crise ou traitement de fond).</p>
</td>
</tr>
<tr>
<td style="text-align: center;">
<p><strong>PDE4i</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">Apremilast</span></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">OTEZLA</span><strong>&reg;</strong></p>
</td>
<td style="text-align: center;">
<p><span style="font-weight: 400;">PO</span></p>
</td>
<td style="text-align: left;">
<p><span style="font-weight: 400;">D&eacute;but du traitement &agrave; 10 mg/jour avec majoration de 10 mg par paliers de 1 jour, jusqu&rsquo;&agrave; </span><strong>60 mg/jour &agrave; r&eacute;partir en 2 prises.</strong></p>
</td>
</tr>
<tr>
<th style="text-align: center;" colspan="5">Biosimilaires</th>
</tr>
<tr>
<td style="text-align: left;" colspan="5">Les&nbsp;<strong>biosimilaires</strong>&nbsp;(m&eacute;dicaments ayant d&eacute;montr&eacute; une efficacit&eacute; et une tol&eacute;rance similaires &agrave; la mol&eacute;cule originale dans un essai clinique randomis&eacute; en double aveugle) sont &agrave; utiliser de pr&eacute;f&eacute;rence pour des raisons m&eacute;dico-&eacute;conomiques :&nbsp;<a href="https://www.ordotype.fr/liens-utiles/medicaments-biosimilaires" target="_blank" rel="noopener">liste des m&eacute;dicaments biosimilaires</a>.</td>
</tr>
</tbody>
</table>

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