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Next Steps When a Biologic Doesn't Help Your RA

Medically Reviewed by Melinda Ratini, DO, MS on February 10, 2022

It may take some trial and error to find the biologic drug that works best for your rheumatoid arthritis (RA), but there's a good reason to keep at it. Most folks eventually find one that helps. And when you do, it may ease your symptoms or cause them to fade completely.

You should start to feel better in 4 to 6 weeks, though sometimes it can take 3 to 6 months to work. Your doctor may also prescribe other medicines that work faster to help you in the meantime.

But if your symptoms don't improve, let your doctor know. The goal is to find the best medicines for you as quickly as possible. Timely treatment helps protect your body from RA damage.

What to Expect

When your doctor first prescribes you a biologic, it's usually an "anti-TNF" drug. These include:

  •  
  • Adalimumab (Humira)
  • Adalimumab-adaz (Hyrimoz), adalimumab-adbm (Cyltezo), adalimumab-afzb (Abrilada), adalimumab-atto (Amgevita), adalimumab-bwwd (Hadlima), adalimumab-fkjp (Hulio) -- biosimilars to Humira
  • Certolizumab (Cimzia)
  • Etanercept (Enbrel)
  • Etanercept-szzs (Erelzi), etanercept-ykro (Eticovo) -- biosimilars to Enbrel
  • Golimumab (Simponi)
  • Infliximab (InflectraRemicade)
  • Infliximab-abda (Renflexis), infliximab-axxq (Avsola), infliximab-dyyb (Inflectra),Infliximab-qbtx (Ixifi) -- biosimilars to Remicade

If the first anti-TNF you try doesn't work for you, your doctor will most likely try another one. If you still don't get relief, they may switch you to another type of biologic. These include:

  • Abatacept (Orencia), which blocks the immune system's T cells to lower inflammation
  • Anakinra (Kineret), which targets interleukin-1, a chemical your body makes that causes inflammation. Your doctor will call this type of drug an "IL-1 blocker."
  • Rituximab (Rituxan), which targets certain B cells, which are part of your immune system
  • Tocilizumab (Actemra), which targets IL-6, a chemical your body makes that causes inflammation. Your doctor will call this type of drug an "IL-6 blocker."

Sometimes, biologic drugs will help you for a while and then don't work as well. It's not clear why. If it happens to you, tell your doctor. They'll probably switch you to another biologic or add another type of RA drug, like methotrexate or sulfasalazine, so your treatment works better.

If treatment with a combination of biologics, traditional DMARDS, or a combination of the two doesn't help, the doctor may suggest a targeted synthetic DMARD, like a Janus kinase (JAK) inhibitor. These drugs block several different areas involved with RA. They include: 

Some people get more help from biologics than others. Experts can't predict who'll respond well and who won't. But they know that people who get treatment in the earlier stages of RA tend to do better than those who've had the disease for many years.

Biologics also work best if you take them on a regular schedule. If you can't do that due to side effects or the cost of the drugs, ask your doctor about your options.

Show Sources

SOURCES:

Patience White, MD, chief public health officer, Arthritis Foundation.

Alan Friedman, MD, spokesman, American College of Rheumatology.

American College of Rheumatology: "Biologic Treatments for Rheumatoid Arthritis," "Anti-TNF," "Tocilizumab."

Arthritis Foundation: "Drug Guide: Biologics."

FDA: "FDA approves Amjevita, a biosimilar to Humira."

News Release, FDA.

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