Biologics for Treating Rheumatoid Arthritis

Aggressive treatment can help prevent long-term disability from rheumatoid arthritis.

So if you have moderate to severe RA and don’t respond to traditional disease-modifying antirheumatic drugs (DMARDs), your doctor will probably say it’s time for a biologic. You might take it alone or along with other rheumatoid arthritis medications.

What Biologics Are Available to Treat RA?

How Do Biologics Work?

These genetically engineered proteins are made from human genes. Unlike other RA medications that affect your entire immune system, biologics zero in on specific parts that control the inflammation process. These include:

B cells: A type of white blood cell

Interleukin-1 (IL-1) or interleukin-6 (IL-6): Inflammatory chemicals your body makes

Janus kinase (JAK): Proteins that trigger the inflammation process

T cells: A type of white blood cell.

T umor necrosis factor: A chemical your body makes that drives the inflammation process

What Are Biosimilars?

Your doctor might give you a biosimilar. These are copies of existing biologics. Like generic medications, they cost less than the original. Unlike generic medications though, they aren’t 100% the same. That’s because biologics are made from living organisms.

Don’t worry, though. Manufacturers have to prove they’re just as safe and effective as the original and that they work the same way. You get the same dose the same way at the same strength.

You’ll know your medication is a biosimilar if it has a dash after the generic name followed by four letters.

What to Expect When You Take a Biologic

The FDA has approved these medications to treat rheumatoid arthritis. You might take a biologic alone or in combination with another arthritis drug. As a general rule, you shouldn’t take different biologic therapies at the same time.

Abatacept (Orencia)

How you take it: By injection or IV

How often you take it: Depends on how you take it. You can get it by injection every week or by IV once a month.

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Most common side effects: Headache, cold, sore throat, and nausea

Your doctor should:

  • Test you for tuberculosis and hepatitis before you take it.
  • Check you for infections, including tuberculosis, while you take it.

How it works: It blocks T cells.

 

Adalimumab (Humira), Adalimumab-atto (Amjevita), Adalimumab-adbm (Cyltezo)

How you take it: By injection

How often you take it: Once every 2 weeks

Most common side effects: Colds, sinus infection, headache, and rash

Your doctor should:

  • Test you for tuberculosis and hepatitis before you take it.
  • Check you for infections, including tuberculosis, while you take it.

How it works: It targets tumor necrosis factor (TNF).

 

Anakinra (Kineret)

How you take it: By injection

How often you take it: Daily

Most common side effects: Pain or skin reactions in the area where you get the shot, colds, headache, and nausea

Your doctor should:

  • Test you for tuberculosis and hepatitis before you take it.
  • Check you for infections, including tuberculosis, while you take it.

How it works: It targets interleukin-1 (IL-1).

 

Certolizumab (Cimzia)

How you take it: By injection

How often you take it: Usually every 2-4 weeks (your doctor will decide)

Most common side effects: Flu or cold, rash, urinary tract infections

Your doctor should:

  • Test you for tuberculosis and hepatitis before you take it.
  • Check you for infections, including tuberculosis, while you take it.

How it works: It targets tumor necrosis factor (TNF).

 

Etanercept (Enbrel), Etanercept-szzs (Erelzi)

How you take it: By injection

How often you take it: 1-2 times each week

Most common side effects: Skin reactions or pain where you get the shot, sinus infections, headache

Your doctor should:

  • Test you for tuberculosis and hepatitis before you take it.
  • Check you for infections, including tuberculosis, while you take it.

How it works: It targets tumor necrosis factor (TNF).

 

Golimumab (Simponi, Simponi Aria)

How you take it: By shot or IV

How often you take it: Monthly if by injection (Simponi), every 8 weeks by IV (Simponi Aria)

Most common side effects: Runny nose; sore throat; hoarseness or laryngitis; pain, skin reactions, or tingling where you got the shot; and viral infections like flu and cold sores.

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Your doctor should:

  • Test you for tuberculosis and hepatitis before you take it.
  • Check you for infections, including tuberculosis, while you take it.

How it works: It targets tumor necrosis factor (TNF).

 

Infliximab (Remicade), Infliximab-abda (Renflexis), Infliximab-dyyb ( Inflectra)

How you take it: By IV

How often you take it: Your doctor will decide on the dose and how often you should take it.

Most common side effects: Respiratory infections (like sinus infections and sore throat), headache, coughing, stomach pain

Your doctor should:

  • Test you for tuberculosis and hepatitis before you take it.
  • Check you for infections, including tuberculosis, while you take it.

How it works: It targets tumor necrosis factor (TNF).

 

Rituximab (Rituxan)

How you take it: By IV

How often you take it: Your first two infusions with an IV are 2 weeks apart. You can repeat the infusions every 6 months.

Common side effects: Reactions to the infusion, chills, infections, body aches, tiredness, low white blood cell count

Your doctor should:

  • Test you for tuberculosis and hepatitis B before you take it.
  • Check you for infections, including tuberculosis, while you take it.

How it works: It targets B cells.

 

Tocilizumab (Actemra)

How you take it: By injection or IV

How often you take it: You can take it by IV once a month. Or you can get injections every week or every other week.

Most common side effects: Cold, sinus infection, headache, high blood pressure, liver problems

Your doctor should:

  • Test you for tuberculosis and hepatitis before you take it.
  • Check you for infections, including tuberculosis, while you take it.

How it works: It targets interleukin-6 (IL-6).

 

Tofacitinib (Xeljanz)

How you take it: As a pill.

How often you take it: Either once or twice a day, depending on the dosage

Most common side effects: Cold, sinus infection, headache, high blood pressure, liver problems

Your doctor should:

How it works: It targets Janus kinase (JAK) proteins.

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Do Biologics Have Side Effects?

The most common are pain and rash at the injection site. But they only affect a small number of people who take these drugs. Biologics can cause allergic reactions. Because they go directly into a vein, you’ll get the infusion at a place where your doctor can keep an eye on you. Reaction symptoms include flu-like illness, fever, chills, nausea, and headache.

As with any drugs that suppress your immune system, biologics can make you more likely to get infections and other diseases. See the doctor ASAP is you have a fever that won’t go away or unexplained symptoms. You may need to get vaccinations to prevent infections before you start a biologic. Don’t get any while you’re taking one, though.

Who Shouldn’t Take Them?

Biologics may cause some dormant chronic diseases (like tuberculosis) to flare. They aren’t a good idea if you have multiple sclerosis or other conditions like severe congestive heart failure. Your doctor will give you a skin or blood test for tuberculosis before you start a biologic. You also need a test for chronic hepatitis B and C.

Although animal studies of biologics show they don’t affect fertility or hurt the baby, they can’t always predict what will happen to humans who take the drugs. Because we don’t know how they affect a developing child, pregnant women should use them only if the need is great.

Your doctor will tell you to stop your biologic before surgery. You can start again when your wounds have healed and your chance of getting an infection has passed.

WebMD Medical Reference Reviewed by David Zelman, MD on March 21, 2018

Sources

SOURCES:

Arthritis Foundation: “Biologics Overview.”

FDA: “FDA’s Overview of the Regulatory Guidelines for the Development and Approval of Biosimilar Products in the US.”

American College of Rheumatology: “Tofacitinib Citrate (Xeljanz).”

MedlinePlus: “Biologics Don't Raise Cancer Risk in Rheumatoid Arthritis Patients.”

Agency for Healthcare Research and Quality: “Rheumatoid Arthritis Medicines: A Guide for Adults.”

UpToDate for Patients: “Patient Information: Rheumatoid Arthritis Treatment.”

The Johns Hopkins Arthritis Center: “Rheumatoid Arthritis Treatment.”

RxList.

News releases, FDA: “FDA approves Inflectra, a biosimilar to Remicade,” "Prescribing Information, Infliximab-dyyb (Inflectra)," “FDA approves Amjevita, a biosimilar to Humira.”

Janssen Biotech Inc.

News release, Roche.

Amgen Prescribing Information, Amjevita.

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