Methotrexate
|
Weekly
|
Continue
|
Sulfasalazine
|
Once or twice daily
|
Continue
|
Hydroxychloroquine
|
Once or twice daily
|
Continue
|
Leflunomide (Arava)
|
Daily
|
Continue
|
Doxycycline
|
Daily
|
Continue
|
BIOLOGICS: STOP these medications prior to surgery and schedule surgery at the end of the dosing cycle. RESUME medications at minimum 14 days after surgery in the absence wound healing problems, surgical site infection or systemic infection.
|
Dosing Interval
|
Schedule Surgery (relative to last biologic dose administered)
|
Adalimumab (Humira) 40 mg
|
Every 2 weeks
|
Week 3
|
Etanercept (Enbrel) 50 mg or 25 mg
|
Weekly or twice weekly
|
Week 2
|
Golimumab (Simponi)50 mg
|
Every 4 weeks (SQ)or
|
Week 5
|
|
Every 8 weeks (IV)
|
Week 9
|
Infliximab (Remicade)3 mg/kg
|
Every 4, 6, or 8 weeks
|
Week 5, 7, or 9
|
Abatacept (Orencia) weight-based 500 mg; IV 1000 mg; SQ
|
Monthly (IV)or
|
Week 5
|
125 mg
|
Weekly (SQ)
|
Week 2
|
Rituximab (Rituxan)1000 mg
|
2 doses 2 weeks apart every 4–6 months
|
Month 7
|
Tocilizumab (Actemra) IV 4 mg/kg;
|
Every week (SQ) or Every 4 weeks
|
Week 3
|
SQ 162 mg
|
(IV)
|
Week 5
|
Anakinra (Kineret) SQ 100 mg
|
Daily
|
Day 2
|
Secukinumab (Cosentyx) 150 mg
|
Every 4 weeks
|
Week 5
|
Ustekinumab (Stela) 45 mg
|
Every 12 weeks
|
Week 13
|
Belimumab (Benlysta) 10 mg/kg
|
Every 4 weeks
|
Week 5
|
Tofacitinib (Xeljanz) 5 mg: STOP this medication 7 days prior to surgery.
|
Daily or twice daily
|
7 days after last dose
|
SEVERE SLE-SPECIFIC MEDICATIONS: CONTINUE these medications in the perioperative period.
|
Dosing Interval
|
Continue/Withhold
|
Mycophenolate
|
Twice daily
|
Continue
|
Azathioprine
|
Daily or twice daily
|
Continue
|
Cyclosporine
|
Twice daily
|
Continue
|
Tacrolimus
|
Twice daily (IV and PO)
|
Continue
|
NOT-SEVERE SLE: DISCONTINUE these medications in the perioperative period.
|
Dosing Interval
|
Continue/Withhold
|
Mycophenolate
|
Twice daily
|
Withhold
|
Azathioprine
|
Daily or twice daily
|
Withhold
|
Cyclosporine
|
Twice daily
|
Withhold
|
Tacrolimus
|
Twice daily (IV and PO)
|
Continue
|