DMARDs: CONTINUE these medications through surgery. | Dosing Interval | Continue/Withhold |
---|---|---|
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 14Â 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) 40Â mg | Every 2Â weeks | Week 3 |
Etanercept (Enbrel) 50Â mg or 25Â mg | Weekly or twice weekly | Week 2 |
Golimumab (Simponi)50Â mg | Every 4Â weeks (SQ)or | Week 5 |
 | Every 8 weeks (IV) | Week 9 |
Infliximab (Remicade)3Â mg/kg | Every 4, 6, or 8Â weeks | Week 5, 7, or 9 |
Abatacept (Orencia) weight-based 500Â mg; IV 1000Â mg; SQ | Monthly (IV)or | Week 5 |
125Â mg | Weekly (SQ) | Week 2 |
Rituximab (Rituxan)1000 mg | 2 doses 2 weeks apart every 4–6 months | Month 7 |
Tocilizumab (Actemra) IV 4Â mg/kg; | Every week (SQ) or Every 4Â weeks | Week 3 |
SQ 162Â mg | (IV) | Week 5 |
Anakinra (Kineret) SQ 100Â mg | Daily | Day 2 |
Secukinumab (Cosentyx) 150Â mg | Every 4Â weeks | Week 5 |
Ustekinumab (Stela) 45Â mg | Every 12Â weeks | Week 13 |
Belimumab (Benlysta) 10Â mg/kg | Every 4Â weeks | Week 5 |
Tofacitinib (Xeljanz) 5Â mg: STOP this medication 7Â days prior to surgery. | Daily or twice daily | 7Â 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 |