Biologics for Rheumatoid Arthritis (RA)

What Are Biologic Drugs?

Biologics are genetically engineered proteins 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.

Why Take Biologics?

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?

What Are the Types of Biologics?

There are several. They include:

  • B-cell inhibitor: They affect B cells, which are white blood cells that carry a protein that can trigger your immune response.
  • Interleukin-1 (IL-1) blocker: Stops production of an inflammatory chemical your body makes
  • Interleukin-6 (IL-6) or interleukin-17 blocker: Stops inflammatory chemicals from attaching to cells
  • Janus kinase (JAK) inhibitor: Blocks proteins that trigger the inflammation process
  • T-cell inhibitor: Blocks communication between T cells, a type of white blood cell
  • T umor necrosis factor (TNF) inhibitor: Blocks 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. Drugmakers 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 with another arthritis drug. As a general rule, you shouldn’t take different biologic therapies at the same time.

Continued

Abatacept (Orencia): This medication works by blocking T cells. You get it in a shot every week or by IV once a month. The most common side effects include headache, a cold, a sore throat, and nausea. Before you start taking it, your doctor should test you for infections such as tuberculosis and hepatitis. They should check you for infections while you’re taking it, too.

Adalimumab (Humira), adalimumab-adbm (Cyltezo), adalimumab-atto (Amjevita): These medications target tumor necrosis factor (TNF). You get them as a shot once every 2 weeks. The most common side effects are colds, a sinus infection, headache, and rash. Before you start taking it, your doctor should test you for infections like tuberculosis and hepatitis. They should check you for infections while you’re taking it, too.

Anakinra (Kineret): This medicine targets interleukin-1 (IL-1). You take it as a shot once a day. The most common side effects are pain or skin reactions in the area where you get the shot, colds, headache, and nausea. Before you start taking it, your doctor should test you for infections like tuberculosis and hepatitis. They should check you for infections while you’re taking it, too.

Certolizumab (Cimzia): This biologic targets tumor necrosis factor (TNF). You take it as a shot every 2-4 weeks. (Your doctor will decide how often you get it.) Its most common side effects are the flu or a cold, a rash, and urinary tract infections. Before you start taking it, your doctor should test you for infections like tuberculosis and hepatitis. They should check you for infections while you’re taking it, too.

Etanercept (Enbrel), etanercept-szzs (Erelzi): This medication targets tumor necrosis factor (TNF). You take it as a shot 1-2 times each week. The most common side effects are skin reactions or pain where you get the shot, sinus infections, and a headache. Before you start taking it, your doctor should test you for infections like tuberculosis and hepatitis. They should check you for infections while you’re taking it, too,

Golimumab (Simponi, Simponi Aria): These biologics target tumor necrosis factor (TNF). You’ll take Simponi as a monthly shot and Simponi Aria every 8 weeks by IV. The most common side effects are a runny nose; sore throat; hoarseness or laryngitis; pain, skin reactions, or tingling where you got the shot; and viral infections like the flu and cold sores. Before you start taking it, your doctor should test you for infections like tuberculosis and hepatitis. They should check you for infections while you’re taking it, too.

Continued

Infliximab (Remicade), infliximab-abda (Renflexis), infliximab-dyyb ( Inflectra): This medication targets tumor necrosis factor (TNF). You take it by IV. Your doctor will decide on the dose and how often you should take it. The most common side effects are respiratory infections (like sinus infections and a sore throat), headache, coughing, and stomach pain. Before you start taking it, your doctor should test you for infections like tuberculosis and hepatitis. They should check you for infections while you’re taking it, too.

Rituximab (Rituxan): This medication targets B cells. You take it as an infusion by IV. Your first two infusions will be 2 weeks apart. You can repeat the infusions every 6 months. The most common side effects are reactions to the infusion, chills, infections, body aches, tiredness, and a low white blood cell count. Before you start taking it, your doctor should test you for infections like tuberculosis and hepatitis. They should check you for infections while you’re taking it, too.

Tocilizumab (Actemra): This medication targets interleukin-6 (IL-6). You can take it by IV once a month. Or you can get shots every week or every other week. The most common side effects are a cold, sinus infection, a headache, high blood pressure, or liver problems. Before you start taking it, your doctor should test you for infections like tuberculosis and hepatitis. They should check you for infections while you’re taking it, too.

Tofacitinib (Xeljanz): This medicine targets Janus kinase (JAK) proteins. You take it as a pill either once or twice a day, depending on the dosage. The most common side effects are a cold, sinus infection, headache, high blood pressure, and liver problems. Before you start taking it, your doctor should test you for infections like tuberculosis. They should check for changes to your cholesterol levels or liver enzymes and track your while blood cell count while you take it, too.

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 if you have a fever 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.

Continued

Who Shouldn’t Take Them?

Biologics may cause some dormant chronic diseases (like tuberculosis) to flare. They may not be 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 Melinda Ratini, DO, MS on September 02, 2018

Sources

SOURCES:

Arthritis Foundation: “Biologics Overview,” “Rheumatoid Arthritis Treatment.”

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.

UpToDate: “Rituximab: Principles of use and adverse effects in rheumatoid arthritis.”

© 2018 WebMD, LLC. All rights reserved.

Pagination