Try Biologics

Biologics

If you have RA with persistent inflammation, biologics may offer benefits. These meds can help reduce pain, swelling, and progressive joint damage. But like any medication, they do have risks. Deciding whether to use them is a big decision. Give yourself time to study the pros and cons of biologics.

Conditions: Rheumatoid arthritis

Symptoms: Symptoms worse in A.M., weakness, fever, reduced joint movement, stiffness, stiffness after rest, deformed joint, stiff joint, swollen joint, warm joint, joint pain

Triggers:

Treatments: abatacept (Orencia), adalimumab (Humira), adalimumab-adbm (Cyltevo), or adalimumab-atto (Amjevita), both biosimilar to Humira,  anakinra (Kineret), azathioprine (Imuran), certolizumab (Cimzia), etanercept (Enbrel), etanercept-szzs (Ereizi), a biosimilar to Enbrel, golimumab (Simponi, Simponia Aria), hydroxychloroquine, infliximab (Remicade), Infliximab-abda (Renflexis) or infliximab-dyyb (Inflectra), both biosimilar to Remicade, rituximab (Rituxan), tocilizumab (Actemra)

Categories: Treatment

Duration

14

Biologics' Promise

Learn about both the risks and benefits of biologics. Biologics have made a huge difference in the lives of many people with RA. These powerful drugs don't just treat the symptoms of RA. Biologics help slow or even stop the progression of joint damage. They target the underlying cause, which typically leads to pain relief and reduces joint damage. Like any medication, they have side effects. But in the long run they can lower your risk of serious complications from RA -- and improve your quality of life.

Prompt: What about biologics?

CTA: Do benefits outweigh the risks?

Conditions: Rheumatoid arthritis

Categories: Meds

How Biologics Work

Wondering how biologics differ from some other RA drugs? Your immune system is supposed to protect your body from germs and foreign substances. But in people with RA, the immune system goes haywire. Instead of protecting your body, the immune cells attack it, including your joints. Biologics are derived from human genes and work by targeting specific parts of your immune system that cause inflammation and joint damage. This helps protect your joints and slows the progress of RA.

Prompt: Immune blockers.

CTA: How biologics work.

Conditions: Rheumatoid arthritis

Treatments: abatacept (Orencia), adalimumab (Humira), adalimumab-adbm (Cyltevo), or adalimumab-atto (Amjevita), both biosimilar to Humira,  anakinra (Kineret), azathioprine (Imuran), certolizumab (Cimzia), etanercept (Enbrel), etanercept-szzs (Ereizi), a biosimilar to Enbrel, golimumab (Simponi, Simponia Aria), hydroxychloroquine, infliximab (Remicade), Infliximab-abda (Renflexis) or infliximab-dyyb (Inflectra), both biosimilar to Remicade, methotrexate, rituximab (Rituxan), tocilizumab (Actemra)

Categories: Treatment

Who Needs Biologics

Doctors don't usually prescribe biologics as a first treatment for RA. So why might your doctor recommend them?

* Blood tests and joint exams show that the RA drugs you take now aren't working well enough.

* You're having serious side effects from your current medications.

In some cases, a doctor may prescribe biologics for a woman who is pregnant or wants to get pregnant. But the data on using biologics during pregnancy is limited. For those women, it's crucial to work with a rheumatologist and an ob-gyn to find the right treatment.

Prompt: Who needs biologics?

CTA: When are they appropriate?

Conditions: Rheumatoid arthritis

Triggers:

Treatments: abatacept (Orencia), adalimumab (Humira), adalimumab-adbm (Cyltevo), or adalimumab-atto (Amjevita), both biosimilar to Humira,  anakinra (Kineret), azathioprine (Imuran), certolizumab (Cimzia), etanercept (Enbrel), etanercept-szzs (Ereizi), a biosimilar to Enbrel, golimumab (Simponi, Simponia Aria), hydroxychloroquine, infliximab (Remicade), Infliximab-abda (Renflexis) or infliximab-dyyb (Inflectra), both biosimilar to Remicade, methotrexate, rituximab (Rituxan), tocilizumab (Actemra)

Categories: Treatment

Decreased Immunity

Biologics work by blocking specific parts of the immune system. While that helps with RA, biologics may make you more susceptible to infections, such as pneumonia and skin infections. Before you start taking biologics, talk to your doctor about your risk of infection. Ask what precautions you might need to take.

Prompt: Infection risk.

CTA: How biologics affect immunity.

Conditions: Rheumatoid arthritis

Triggers:

Treatments: abatacept (Orencia), adalimumab (Humira), adalimumab-adbm (Cyltevo), or adalimumab-atto (Amjevita), both biosimilar to Humira,  anakinra (Kineret), azathioprine (Imuran), certolizumab (Cimzia), etanercept (Enbrel), etanercept-szzs (Ereizi), a biosimilar to Enbrel, golimumab (Simponi, Simponia Aria), hydroxychloroquine, infliximab (Remicade), Infliximab-abda (Renflexis) or infliximab-dyyb (Inflectra), both biosimilar to Remicade, methotrexate, rituximab (Rituxan), tocilizumab (Actemra)

Categories: Treatment

Don't Delay

If your doctor recommends a biologic, you may wonder if you need it -- especially if your RA symptoms don't seem that bad. However, RA may be doing serious damage even if you don't feel it yet. You're not just risking achy joints. Untreated RA with ongoing inflammation can cause debilitating pain, eye problems, lung problems, and disability. It significantly raises your risk for heart disease. Biologics can help prevent that damage from taking place, avoiding serious consequences later.

Prompt: Don't wait and see.

CTA: Why you need early treatment.

Conditions: Rheumatoid arthritis

Symptoms: Loss of appetite, fatigue, feeling sick, symptoms worse in A.M., weakness, fever, lumps under skin, reduced joint movement, stiffness, stiffness after rest, anxiety, depression, deformed joint, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, symmetrical pain, numbness, tingling

Triggers:

Treatments: Prescription medications, abatacept (Orencia), adalimumab (Humira), adalimumab-adbm (Cyltevo), or adalimumab-atto (Amjevita), both biosimilar to Humira, anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), etanercept-szzs (Ereizi), a biosimilar to Enbrel,  golimumab (Simponi, Simponia Aria)hydroxychloroquine (Plaquenil), infliximab (Remicade), infliximab-dyyb (Inflectra), a biosimilar to Remicade, leflunomide (Arava), methotrexaterituximab (Rheumatrex,  Rituxan), sulfasalazine (Azulfidine), tocilizumab (Actemra).,

Categories: Treatment

Biologics and Safety

Your doctor will consider your overall health when deciding whether you need biologics. Biologics are not right for everyone. Certain biologics may not be safe for people with some health conditions, such as hepatitis, heart failure, or multiple sclerosis. People who are planning to get surgery may need to wait until after the operation to start a biologic. Talk to your doctor about whether you have any health conditions that might make using biologics unwise.

Prompt: Not for me?

CTA: When biologics aren't recommended.

Conditions: Rheumatoid arthritis

Symptoms: Loss of appetite, fatigue, feeling sick, symptoms worse in A.M., weakness, fever, lumps under skin, reduced joint movement, stiffness, stiffness after rest, anxiety, depression, deformed joint, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, symmetrical pain, numbness, tingling

Triggers:

Treatments: Prescription medications, abatacept (Orencia), adalimumab (Humira), adalimumab-adbm (Cyltevo) or adalimumab-atto (Amjevita), both biosimilar to Humira, anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), etanercept-szzs (Ereizi), a biosimilar to Enbrel,  golimumab (Simponi, Simponia Aria)hydroxychloroquine (Plaquenil), infliximab (Remicade), infliximab-dyyb (Inflectra), a biosimilar to Remicade, leflunomide (Arava), methotrexaterituximab (Rheumatrex,  Rituxan), sulfasalazine (Azulfidine), tocilizumab (Actemra).,

Categories: Treatment

Combining Meds

Doctors don't usually prescribe biologics as the only treatment. Most people with RA keep taking other drugs -- such as methotrexate -- along with a biologic. Ask your doctor what other drugs you might keep using if you started taking a biologic. But for now, doctors don't use more than one biologic at a time. Combining them seems to increase the risk of infection.

Prompt: Multiple meds?

CTA: Using biologics with other drugs.

Conditions: Rheumatoid arthritis

Symptoms: Loss of appetite, fatigue, feeling sick, symptoms worse in A.M., weakness, fever, lumps under skin, reduced joint movement, stiffness, stiffness after rest, anxiety, depression, deformed joint, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, symmetrical pain, numbness, tingling

Triggers:

Treatments: Prescription medications, abatacept (Orencia), adalimumab (Humira), adalimumab-adbm (Cyltevo) or adalimumab-atto (Amjevita), both biosimilar to Humira, anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), etanercept-szzs (Ereizi), a biosimilar to Enbrel,  golimumab (Simponi, Simponia Aria)hydroxychloroquine (Plaquenil), infliximab (Remicade), infliximab-dyyb (Inflectra), a biosimilar to Remicade, leflunomide (Arava), methotrexaterituximab (Rheumatrex,  Rituxan), sulfasalazine (Azulfidine), tocilizumab (Actemra).,

Categories: Treatment

Injecting Biologics

You can't take a biologic in pill form. Biologics come as injections or infusions. If your biologic comes as an injection, you will learn how to give yourself the shots at home. People usually give themselves the injections in the abdomen or the thigh. You should rotate injection sites to prevent irritation. The dosing depends on the drug. Some people need daily injections. Others only need them twice a month.

Prompt: Biologic injections.

CTA: How to take some biologics.

Conditions: Rheumatoid arthritis

Symptoms: Loss of appetite, fatigue, feeling sick, symptoms worse in A.M., weakness, fever, lumps under skin, reduced joint movement, stiffness, stiffness after rest, anxiety, depression, deformed joint, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, symmetrical pain, numbness, tingling

Triggers:

Treatments: Prescription medications, adalimumab (Humira), adalimumab-adbm (Cyltevo) or adalimumab-atto (Amjevita), both biosimilar to Humira,  anakinra ( Kineret), certolizumab (Cimzia), etanercept (Enbrel), etanercept-szzs (Ereizi), a biosimilar to Enbrel, golimumab (Simponi, Simponi Aria)

Categories: Treatment

Infusing Biologics

Some biologics comes as an infusion rather than a shot. You'll need to need to go to your doctor's office or a medical center to get an IV. These infusions usually take a few hours. During this time you can read, rest, watch TV, or catch up on work. At first, you may need to get infusions every few weeks. Over time, you may not need them as often.

Prompt: Biologics by infusion.

CTA: Getting biologics by IV.

Conditions: Rheumatoid arthritis

Symptoms: Loss of appetite, fatigue, feeling sick, symptoms worse in A.M., weakness, fever, lumps under skin, reduced joint movement, stiffness, stiffness after rest, anxiety, depression, deformed joint, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, symmetrical pain, numbness, tingling

Triggers:

Treatments: Prescription medications, abatacept (Orencia), infliximab (Remicade), rituximab (Rituxan), tocilizumab (Actemra)

Categories: Treatment

Vaccine Safety

If you're due for any vaccines, you may need to get them 1-3 months before you start taking a biologic. Some vaccines can increase the risk of an infection when you are taking a drug like a biologic that suppresses the immune system. Before you start a biologic, check with your doctor to make sure you're up to date on all your vaccines.

Prompt: Need vaccines?

CTA: Get them before starting biologics.

Conditions: Rheumatoid arthritis

Symptoms: Loss of appetite, fatigue, feeling sick, symptoms worse in A.M., weakness, fever, lumps under skin, reduced joint movement, stiffness, stiffness after rest, anxiety, depression, deformed joint, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, symmetrical pain, numbness, tingling

Triggers:

Treatments: Prescription medications, abatacept  (Orencia), adalimumab (Humira), adalimumab-adbm (Cyltevo), or adalimumab-atto (Amjevita), both biosimilar to Humira, anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), etanercept-szzs (Ereizi), a biosimilar to Enbrel, golimumab (Simponi, Simponi Aria), hydroxychloroquine (Plaquenil), infliximab (Remicade), leflunomide (Arava), rituximab (Rituxan), methotrexate, rituximab (Rheumatrex, Rituxan), sulfasalazine (Azulfidine), tocilizumab (Actemra)

Categories: Treatment

Biologics and TB and Hepatitis B and C

Before you start taking a biologic, your doctor will test you for tuberculosis. TB can sometimes hide in the body for years without causing any symptoms. However, starting a biologic can cause it to flare up. If you test positive, your doctor can likely use medication to kill the bacteria and then start the biologic after they're gone. 

Your doctor will also want to screen you for hepatitis B and C. Both of these chronic infections can become worse after starting biologics and may be a reason not to use them

Prompt: Biologics and TB?

CTA: Get tested.

Conditions: Rheumatoid arthritis

Symptoms: Loss of appetite, fatigue, feeling sick, symptoms worse in A.M., weakness, fever, lumps under skin, reduced joint movement, stiffness, stiffness after rest, anxiety, depression, deformed joint, stiff joint, swollen joint, warm joint, joint pain, muscle pain, pain, lower back pain, upper back pain, symmetrical pain, numbness, tingling

Triggers:

Treatments: Prescription medications, abatacept (Orencia), adalimumab (Humira), adalimumab-adbm (Cyltevo), or adalimumab-atto (Amjevita), both biosimilar to Humira, anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), etanercept-szzs (Ereizi), a biosimilar to Enbrel, golimumab (Simponi, Simponi Aria), hydroxychloroquine (Plaquenil), infliximab (Remicade), leflunomide (Arava), rituximab (Rituxan), methotrexate, rituximab (Rheumatrex, Rituxan), sulfasalazine (Azulfidine), tocilizumab (Actemra)

Categories: Treatment

WebMD Medical Reference Reviewed by David Zelman, MD on September 07, 2019

Sources

SOURCES:

Saag, K. Arthritis & Rheumatism, June 15, 2008.

American College of Rheumatology: “Position statement: biologic agents for rheumatic diseases.” “Biologic Treatments for Rheumatoid Arthritis.”

Choy, E. New England Journal of Medicine, 2001.

National Institute of Arthritis and Musculoskeletal and Skin Diseases: “Handout on Health: Rheumatoid Arthritis.”

Douglas Conaway, MD, rheumatologist, Carolina Health Specialists, Myrtle Beach, S.C.

Johns Hopkins Arthritis Center: “Rheumatoid Arthritis Treatment.”

Clifton Bingham, MD, associate professor of medicine, Johns Hopkins University; associate director, Johns Hopkins Arthritis Center, Baltimore.

Eric L. Matteson, MD, chair, department of rheumatology, Mayo Clinic, Rochester, Minn.

Arthritis Foundation: "Precautions to Take Before Starting Biologics," "Biologics: Learn About These Treatments for Rheumatoid Arthritis and Other Diseases."

© 2019 WebMD, LLC. All rights reserved.