Biologics for Rheumatoid Arthritis: No Cure-all

Biologic Therapies Ease but Don't Eliminate RA Symptoms, Study Says

Medically Reviewed by Louise Chang, MD on May 01, 2009

May 1, 2009 -- Biologic therapies often prescribed for rheumatoid arthritis do help improve symptoms but don't eliminate them, according to a new study.

However, patients who remain on subcutaneous biologic therapies -- medications injected under the skin -- have fewer symptoms than those who discontinue the drugs, says study author Boxiong Tang, MD, director of health economics and clinical outcomes research for Centocor Ortho Biotech Inc., in Horsham, Pa., a manufacturer of biologic therapies.

Tang presented his study looking at how the biologic medications improved quality of life, functioning, and work productivity this week in San Diego at the American Occupational Health Conference sponsored by the American College of Occupational and Environmental Medicine.

Biologics for RA: Background

"Rheumatoid arthritis is a leading cause of disability," Tang tells WebMD. The chronic disease is marked by inflammation of the lining of the joints, which can lead to joint damage and chronic pain. "Patients who suffer from the disease have a reduced quality of life," Tang says. Their work productivity can decline and their daily functioning can be difficult because of the pain.

RA affects about 1.3 million Americans, according to the Arthritis Foundation. Biologics, also called biologic response modifiers, are considered an important advance in RA treatment in the past decade. The medicines are given by injection or intravenous infusion. Among the options are Enbrel, Humira, Remicade, Kineret, Rituxan, Orencia, and the newest, Simponi -- approved in April and made by Centocor.

Biologics for RA: Study Details

Tang's goal in looking at the patients who were taking subcutaneous biologics, he says, is to see how the newer drugs are working out.

Tang and his colleagues extracted data from the National Health and Wellness Survey, a database created by Consumer Health Sciences, a company that markets the information to pharmaceutical and life science companies.

The RA Patient Survey included 2,048 patients, but just 362 were prescribed subcutaneous biologic therapy. Of the 362, 214 RA patients continued on the treatments and the other 148 had stopped them. Nearly 78% of the patients were women and the average age was 50.

Tang's team evaluated signs and symptoms such as morning stiffness, fatigue, and joint pain, as well as quality of life by using a common scale to assess mental and physical component scores. They compared current users' symptoms and quality of life with those who had stopped the drugs.

Those still taking the biologics, he says, "still suffered from some degree of pain, morning stiffness, and have a reduced quality of life."

But those who stopped the drug reported "significantly worse scores" for fatigue, pain, and quality of life measures, he says. They also lost more work time and had more impairment in daily activities, he says, but the differences in this area did not reach statistical significance.

The findings suggest that RA patients' medical needs are not being totally met, Tang says. Centocor supported the study.

Rheumatoid Arthritis Relief: Second Opinion

The study findings ring true in clinical practice, says Scott Zashin, MD, a rheumatologist at Presbyterian Hospitals of Dallas and Plano, Texas, and a clinical assistant professor of internal medicine at the University of Texas Southwestern Medical Center in Dallas.

Complicating the picture, he says, is that RA patients may have other problems, such as fibromyalgia, a disorder also marked by chronic pain.

He tells patients to expect the best from biologic treatment and to focus on the goal -- putting them in remission -- but to understand that it may not happen.

Rheumatoid Arthritis: Beyond Medications

In addition to medication, Tang says, RA patients can pay attention to lifestyle habits. Exercising regularly and not smoking are both good measures, he says.

Zashin agrees. Among the specific suggestions he gives his RA patients to reduce pain, stiffness, fatigue, and other symptoms:

  • Get enough sleep. The hours needed will vary from patient to patient, but he tells patients to get enough sleep so they wake up feeling refreshed.
  • Do aerobic exercise for 30 minutes five days a week. Walking and swimming are two good choices.
  • Control stress in your life. Meditation is one way.
  • Be open to alternative treatments. For example, in patients with RA who also have osteoarthritis, the "wear-and-tear" form, Zashin says he has had success using acupuncture treatments.