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HUMIRA Is Administered by Subcutaneous Injection INITIAL DOSE FOLLOWED BY

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HUMIRA Is Administered by Subcutaneous Injection INITIAL DOSE FOLLOWED BY OFFERING IN-OFFICE ‘FACE LIFTS’ P. 20 • OPTIMIZING GLAUCOMA SURGERY P. 44 Review of Ophthalmology Vol. XXIII, No. 9 • September 2016 • Perfecting Posterior Corneal • ECP Grafts • Making the Most of Cross-linking AMDReview of Ophthalmology Vol. XXIII, Posterior Therapies and Cataract Surgery No. 9 • September 2016 • Perfecting IN SEARCH OF THE BEST AMD THERAPY P. 51 • HOW TO ASSESS SYMPTOMS IN DRY EYE P. 58 COMBINING ECP AND CATARACT SURGERY P. 62 • WILLS EYE RESIDENT CASE STUDY P. 71 September 2016 reviewofophthalmology.com ANNUAL CORNEA ISSUE Surmounting Challenges In Cornea Approvals of new technologies and the evolution of surgical techniques make it easier for you to achieve excellent outcomes. Perfecting Making the Most Posterior Corneal of Cross-linking Grafts P. 24 P. 32 001_rp0916_fc.indd 1 8/26/16 1:44 PM New Indication. New Dosing Regimen. HUMIRA is administered by subcutaneous injection INITIAL DOSE FOLLOWED BY given every other week starting 80 mg 40 mg 1 week after the initial dose The fi rst injection should be given under the supervision of a healthcare professional. A patient may self-inject HUMIRA after appropriate training and monitoring by a healthcare professional. Visit www.HumiraPro.com to learn more about our education programs for NI uveitis.* *Intermediate, posterior, and panuveitis. Indication¹ Uveitis: HUMIRA is indicated for the treatment of non-infectious intermediate, posterior, and panuveitis in adult patients. IMPORTANT SAFETY INFORMATION FOR HUMIRA® (adalimumab)1 SERIOUS INFECTIONS If an infection develops, monitor carefully and initiate Patients treated with HUMIRA are at increased risk for appropriate therapy. developing serious infections that may lead to hospitalization Drug interactions with biologic products: A higher rate of serious or death. Most patients who developed these infections infections has been observed in rheumatoid arthritis patients treated were taking concomitant immunosuppressants such as with rituximab who received subsequent treatment with a TNF methotrexate or corticosteroids. blocker. Concurrent use of HUMIRA with biologic DMARDs (e.g., Discontinue HUMIRA if a patient develops a serious infection anakinra or abatacept) or other TNF blockers is not recommended or sepsis. based on the possible increased risk for infections and other potential Reported infections include: pharmacological interactions. Active tuberculosis (TB), including reactivation of latent MALIGNANCY TB. Patients with TB have frequently presented with disseminated or extrapulmonary disease. Test patients for Lymphoma and other malignancies, some fatal, have been latent TB before HUMIRA use and during therapy. Initiate reported in children and adolescent patients treated with treatment for latent TB prior to HUMIRA use. TNF blockers, including HUMIRA. Postmarketing cases of hepatosplenic T-cell lymphoma (HSTCL), a rare type of T-cell Invasive fungal infections, including histoplasmosis, coccidioidomycosis, candidiasis, aspergillosis, lymphoma, have been reported in patients treated with TNF blastomycosis, and pneumocystosis. Patients with blockers, including HUMIRA. These cases have had a very histoplasmosis or other invasive fungal infections may aggressive disease course and have been fatal. The majority present with disseminated, rather than localized, disease. of reported TNF blocker cases have occurred in patients Antigen and antibody testing for histoplasmosis may be with Crohn’s disease or ulcerative colitis and the majority negative in some patients with active infection. Consider were in adolescent and young adult males. Almost all of empiric anti-fungal therapy in patients at risk for invasive these patients had received treatment with azathioprine or fungal infections who develop severe systemic illness. 6-mercaptopurine concomitantly with a TNF blocker at or prior to diagnosis. It is uncertain whether the occurrence of Bacterial, viral, and other infections due to opportunistic pathogens, including Legionella and Listeria. HSTCL is related to use of a TNF blocker or a TNF blocker in combination with these other immunosuppressants. Carefully consider the risks and benefits of treatment with HUMIRA prior to initiating therapy in patients: 1. with chronic or Consider the risks and benefits of HUMIRA treatment prior to initiating recurrent infection, 2. who have been exposed to TB, 3. with a or continuing therapy in a patient with known malignancy. history of opportunistic infection, 4. who resided in or traveled In clinical trials, more cases of malignancies were observed among in regions where mycoses are endemic, 5. with underlying HUMIRA-treated patients compared to control patients. conditions that may predispose them to infection. Monitor Non-melanoma skin cancer (NMSC) was reported during clinical trials patients closely for the development of signs and symptoms of for HUMIRA-treated patients. Examine all patients, particularly those infection during and after treatment with HUMIRA, including with a history of prolonged immunosuppressant or PUVA therapy, for the possible development of TB in patients who tested negative the presence of NMSC prior to and during treatment with HUMIRA. for latent TB infection prior to initiating therapy. In HUMIRA clinical trials, there was an approximate 3-fold higher Do not start HUMIRA during an active infection, including rate of lymphoma than expected in the general U.S. population. localized infections. Patients with chronic inflammatory diseases, particularly those with Patients older than 65 years, patients with co-morbid conditions, highly active disease and/or chronic exposure to immunosuppressant and/or patients taking concomitant immunosuppressants may be at therapies, may be at higher risk of lymphoma than the general greater risk of infection. population, even in the absence of TNF blockers. RP0816_Abbvie.indd 2 7/21/16 3:47 PM NOW APPROVED HUMIRA for NI intermediate, posterior, and panuveitis* A steroid-sparing option proven to prolong time to a combination of disease fl are† and decrease of visual acuity.1 †Disease flare is defined by an increase in 1 or more inflammatory markers: AC cells, vitreous haze, and/or development of new chorioretinal, and/or retinal vascular lesions. Postmarketing cases of acute and chronic leukemia were reported HEMATOLOGIC REACTIONS with TNF blocker use. Approximately half of the postmarketing Rare reports of pancytopenia, including aplastic anemia, have been cases of malignancies in children, adolescents, and young adults reported with TNF blockers. Medically significant cytopenia has been receiving TNF blockers were lymphomas; other cases included rare infrequently reported with HUMIRA. malignancies associated with immunosuppression and malignancies Consider stopping HUMIRA if significant hematologic abnormalities not usually observed in children and adolescents. occur. HYPERSENSITIVITY CONGESTIVE HEART FAILURE Anaphylaxis and angioneurotic edema have been reported following Worsening or new onset congestive heart failure (CHF) may occur; HUMIRA administration. If a serious allergic reaction occurs, stop exercise caution and monitor carefully. HUMIRA and institute appropriate therapy. HEPATITIS B VIRUS REACTIVATION AUTOIMMUNITY Treatment with HUMIRA may result in the formation of autoantibodies Use of TNF blockers, including HUMIRA, may increase the risk of and, rarely, in development of a lupus-like syndrome. Discontinue reactivation of hepatitis B virus (HBV) in patients who are chronic treatment if symptoms of a lupus-like syndrome develop. carriers. Some cases have been fatal. Evaluate patients at risk for HBV infection for prior evidence of HBV IMMUNIZATIONS infection before initiating TNF blocker therapy. Patients on HUMIRA should not receive live vaccines. Exercise caution in patients who are carriers of HBV and monitor them Pediatric patients, if possible, should be brought up to date with all during and after HUMIRA treatment. immunizations before initiating HUMIRA therapy. Discontinue HUMIRA and begin antiviral therapy in patients who The safety of administering live or live-attenuated vaccines in infants develop HBV reactivation. Exercise caution when resuming HUMIRA exposed to HUMIRA in utero is unknown. Risks and benefits should after HBV treatment. be considered prior to vaccinating (live or live-attenuated) exposed NEUROLOGIC REACTIONS infants. TNF blockers, including HUMIRA, have been associated with rare ADVERSE REACTIONS cases of new onset or exacerbation of central nervous system and The most common adverse reactions in HUMIRA clinical trials (>10%) peripheral demyelinating diseases, including multiple sclerosis, optic were: infections (e.g., upper respiratory, sinusitis), injection site neuritis, and Guillain-Barré syndrome. reactions, headache, and rash. Exercise caution when considering HUMIRA for patients with these disorders; discontinuation of HUMIRA should be considered if any of these disorders develop. There is a known association between intermediate uveitis and central demyelinating disorders. Reference: 1. HUMIRA Injection [package insert]. North Chicago, IL: AbbVie Inc. Please see Brief Summary of full Prescribing Information on the following page. ©2016 AbbVie Inc. North Chicago, IL 60064 64C-1859319 June 2016 Printed in U.S.A. RP0816_Abbvie.indd 3 7/21/16 3:47 PM ® (adalimumab) PROFESSIONAL BRIEF SUMMARY HUMIRA CONSULT PACKAGE INSERT FOR FULL PRESCRIBING INFORMATION Uveitis In controlled trials of other TNF blockers in adult patients at higher risk for WARNING: SERIOUS
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