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Biologic response modifiers (BRMs), also known as immunomodulators, are the class of medications that target the disease-causing mechanism. They are used in autoimmune diseases as first-line medications or after the failure of conventional agents. Serious infections are the most feared complications and require screening before initiation, and monitoring while patients are taking the medications. This activity reviews the evaluation and management of various autoimmune conditions with the use of BRMs and highlights the role of the interprofessional team in evaluating and treating patients with these medications. Objectives: Describe the indications for biologic response modifiers. Identify the adverse events associated with biologic response modifiers. Review the importance of monitoring patients taking biologic response modifiers. Explain the importance of improving care coordination among the interprofessional team to improve outcomes for patients receiving biologic response modifiers. Access free multiple choice questions on this topic.

Biologic response modifiers can often cause bone marrow suppression, hepatotoxicity, cardiopulmonary and renal dysfunction, disseminated intravascular coagulation, and often death. Toxicity is usually due to immune system activation and is manageable by premedication or adjusting dose.[44]

Early treatment with a biologic response modifier improves outcomes and prevents disability related to autoimmune diseases; however, currently, no clinical predictors or biomarkers are available to guide physicians to select BRM for an individual patient. Not all patients with the same illness respond to particular BRM. Genetic polymorphism in the genes encoding the receptors that the BRM targets affect the efficacy of BRM. Performing genetic tests before starting the treatment may help in choosing a specific BRM for a particular patient. It is crucial to consider patient-related factors, e.g., patient convenience, local availability, patient's understanding of risks of medication, route, the frequency of administration, and cost-effectiveness while choosing BRM. The patient should be actively involved while choosing and making a treatment decision, and they should be aware of the adverse effects of the medication under consideration. Nursing can help the patient with administration instructions and a discussion about possible side effects. The pharmacist must verify the dosing of the agent, check for drug-drug interactions, and also counsel the patient on signs of potential adverse effects. Nursing and pharmacy both need to have an open line of communication with the prescriber to adjust treatment if necessary. BRM therapy requires an interprofessional team approach, including physicians, specialists, specialty-trained nurses, and pharmacists, all collaborating across disciplines to achieve optimal patient results. [Level V]