In the last decade, there have been significant advances in treating rheumatoid arthritis, especially for patients whose arthritis does not respond to traditional disease-modifying antirheumatic drugs (DMARDs). The most important advance has been the development of a group of drugs called biologic response modifiers or biologics.
There are a number of biologics approved to treat rheumatoid arthritis. These include:
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Other biologics are being studied to treat rheumatoid arthritis as well as other conditions.
How Do Biologics Treat Rheumatoid Arthritis?
Biologics are genetically engineered proteins derived from human genes. They are designed to inhibit specific components of the immune system that play pivotal roles in fueling inflammation, which is a central feature of rheumatoid arthritis.
Biologics are used to treat moderate to severe rheumatoid arthritis that has not responded adequately to other treatments. They differ significantly from traditional drugs used to treat rheumatoid arthritis in that they target specific components of the immune system instead of broadly affecting many areas of the immune system. Biologics may be used alone but are commonly given along with other rheumatoid arthritis medications.
Biologics have been shown to help slow progression of rheumatoid arthritis when all other treatments have failed to do so. Aggressive rheumatoid arthritis treatment is known to help prevent long-term disability from RA.
What Are the Side Effects of Biologics?
The most common side effect seen with biologics is pain and rash at the injection site. This occurs in less than 30% of patients. Since biologics given by infusion (in the vein) have the potential to cause an allergic infusion reaction, patients are monitored during infusions. Symptoms of infusion reactions include flu-like illness, fever, chills, nausea, and headache.
As with any drugs that suppress the immune system, biologic therapy poses some increased to infections and other diseases. People taking biologics should seek immediate medical attention if they develop persistent fever or unexplained symptoms. Vaccinations that prevent infections should be considered prior to taking biologics. While taking biologic medications people should not receive live vaccines.
Biologics may also cause some chronic diseases that are dormant (such as tuberculosis) to flare, and they are not recommended for people with multiple sclerosis and other conditions such as severe congestive heart failure. All patients should be skin tested for tuberculosis prior to starting biologics, and many are also tested for chronic hepatitis.
Biologics are also more expensive than traditional treatments. However, the evidence so far suggests that they are more effective and may pose fewer risks than other systemic therapies.
One disadvantage to biologic medications is that they must be given either by injection or by intravenous infusion, with the exception of Xeljanz. It is taken by mouth
Although animal studies of biologics have shown no effect on fertility or impairment of the fetus, these studies cannot always predict the effects in humans. Pregnant women should receive these drugs only if clearly needed because the effects on a developing child are unknown.
Biologics are commonly discontinued prior to surgery until wounds have sealed and infection risk has passed.
As a general rule, different biologic therapies should not be taken at the same time.
Here are some details on available biologic drugs: