Perioperative Management of Ziltivekimab for Surgery
Ziltivekimab should be withheld prior to surgery following the general principles for biologic agents, with discontinuation recommended at least twice the half-life before major surgery (approximately 90-130 days based on its 45-65 day half-life). 1, 2
Understanding Ziltivekimab
Ziltivekimab is a fully human monoclonal antibody targeting interleukin-6 (IL-6), used to suppress inflammation in patients with chronic kidney disease and elevated inflammatory markers. Key characteristics include:
- Long half-life of 45-65 days, requiring consideration for perioperative planning 1
- Primarily used for reducing inflammatory burden as measured by C-reactive protein 3
- As a biologic agent, it has immunomodulatory effects that could potentially impact surgical outcomes 2
Perioperative Management Recommendations
Preoperative Considerations
- Withhold ziltivekimab before major surgery, following the general principle for biologics of discontinuing for at least twice the drug's half-life (approximately 90-130 days) 2
- For minor procedures with low infection risk, continuation may be considered, though specific data for ziltivekimab is limited 2
- This approach aligns with recommendations for other biologics, where withholding prior to surgery and planning surgery after the next dose is due is conditionally recommended 4
Risk Assessment
- Consider both the risk of surgical site infection and the risk of disease flare when deciding on perioperative management 5
- Evaluate the patient's inflammatory burden and the potential impact of discontinuing anti-inflammatory therapy 3
- Assess the type of surgery (major vs. minor) as this influences the decision to withhold or continue therapy 2
Postoperative Considerations
- Resume ziltivekimab once the wound shows evidence of healing, sutures/staples are removed, there is no significant swelling, erythema, or drainage, and there is no ongoing infection (typically around 14 days postoperatively) 4
- Monitor for signs of infection or delayed wound healing, which are potential concerns with immunomodulatory biologics 2
Special Considerations
- For patients with severe underlying inflammatory conditions, the decision to withhold ziltivekimab should be balanced against the risk of disease flare 5
- Consider the surgical procedure's complexity and infection risk when making decisions about perioperative management 2
- While specific guidelines for ziltivekimab are not yet established, following recommendations for similar biologic agents is prudent until more specific evidence emerges 4
Practical Approach
- Discuss the perioperative plan with the prescribing physician to coordinate care 5
- Document the decision-making process regarding continuation or discontinuation 6
- Ensure patients understand the rationale for medication management to improve adherence 6
- Consider alternative anti-inflammatory strategies during the perioperative period if needed 3