Medications called biologic response modifiers have given new hope to people with rheumatoid arthritis (RA) and the doctors who treat them. Until the late ’90s, people with RA looked at a future of pain, lost function, and eventual disability. Biologics have changed that outlook.
Many people now live with significantly less pain and more function, but may worry about side effects. Here's a look at the risks and benefits of biologics.
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Ed Clough’s story demonstrates how biologics have changed the RA picture. He was first diagnosed in the early ’90s and advised to take ibuprofen for pain. “It didn’t do much,” he says.
Then, for no apparent reason, his RA went into remission. A few years later, it came back with a vengeance. “The pain in my fingers and wrists got so bad I couldn’t button my shirt or lift a gallon of milk without dropping it,” he says. “Things I never used to think about.”
The return of Clough’s RA coincided with the FDA’s 1998 approval of the first two biologic agents on the U.S. market. The drugs were so new that Clough’s doctor had to put him on a special list to qualify for the treatment. “Within weeks of the first injection, I could manage everyday activities again,” Clough says. “I played golf without pain for the first time in years.”
What Are Biologics?
Biologics are a class of drug that target specific parts of the immune system. With RA, the immune system goes into overdrive and attacks healthy cells. So bringing the immune system under control is key to managing the disease.
This approach is not new, exactly. Some disease-modifying antirheumatic drugs (DMARDs) that have been around for decades. But many work by suppressing the whole immune system, rather than specific parts of it.
“Biologics are the first agents developed specifically with RA in mind,” says Theodore R. Fields, MD, clinical director of the Early Arthritis Initiative at the Hospital for Special Surgery. “Some were originally developed as chemo drugs, others to treat tuberculosis. The new agents target specific chemicals in the immune system so you see more benefits without as much collateral damage.”
RA Treatment Revolution
“Biologics have elevated the goals of treatment,” says Arthur Kavanaugh, MD, professor of clinical medicine in the Rheumatology Division at the University of California, San Diego. “We’re treating the disease earlier and more aggressively with much higher expectations for patient outcomes.”
Researchers now recognize that the first year is a critical time to treat RA. Often much of the bone and joint damage occurs early, within a few weeks of onset. Biologics do not reverse existing damage, but can protect the joints against continued damage and have been shown to slow the progression of the disease. They are considered a possible treatment for patients who have uncontrolled RA despite the use of DMARDs.