Understanding Biologic Drugs for Arthritis Treatment

Biologic drugs are among the medications used to treat rheumatoid arthritis (RA). These medications reduce immune cell activity to decrease the inflammation that damages joints in this condition.

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Biologic Drugs and Their Targets

There are a variety of biologic drugs, each of which targets a specific type of molecule involved in the inflammatory process—such as tumor necrosis factor (TNF), interleukins (ILs), and cell surface molecules on T and B lymphocytes.

  • Enbrel (etanercept), Remicade (infliximab), Humira (adalimumab), Simponi (golimumab), and Cimzia (certolizumab pegol) target TNF. Often, TNF blockers are considered first-line biologics in RA.
  • Stelara (ustekinumab) blocks IL-12 and IL-23 cytokines.
  • Taltz (ixekizumab) and Cosentyx (secukinumab) inhibit IL-17 and are used to treat moderate to severe plaque psoriasis and active psoriatic arthritis.
  • Orencia (abatacept) interrupts the activation of T cells. Usually, Orencia is reserved for patients with moderate to severe RA whose disease is not adequately controlled with methotrexate and a TNF blocker.
  • Rituxan (rituximab) depletes B cells. This drug is typically reserved for patients who have an unsatisfactory result with methotrexate and a TNF blocker.
  • Actemra (tocilizumab) works by inhibiting the IL-6 receptor and is used to treat moderate to severe RA, polyarticular juvenile idiopathic arthritis, and systemic juvenile idiopathic arthritis.
  • Kineret (anakinra) inhibits IL-1. It is effective for treating several inflammatory conditions, but it is less effective in the treatment of RA.

Who Should Be Treated With Biologics?

If you've had an unsatisfactory response to disease-modifying antirheumatic drugs (DMARDs), either alone or in combination with other arthritis medications, you might be a good candidate for biologics.

Biologics can take up to three months to be fully effective.

Who Should Not Be Treated With Biologics?

You might not be a good candidate for treatment with biologic drugs. There are certain conditions in which the risks would most likely outweigh the benefits of treatment.

For example, if you have multiple sclerosis, symptomatic congestive heart failure, or a history of lymphoma, TNF inhibitors wouldn't be right for you. It's also too risky to use biologic drugs if you have a history of severe or recurring infections.

Which of the Biologics Should You Use?

Your doctor will help you choose the best biologic for you. Cost is certainly a consideration. You and your doctor must determine if your health insurance will cover the cost and what your out-of-pocket expense will be.

Another consideration is convenience. How is the drug administered? Do you have to go to the doctor's office for treatment or would it be better for you to choose one of the biologic drugs that are administered as a self-injection? How often is the drug administered—once a week, twice a week, every two weeks, or monthly? What's your preference?

Also, is it important for you to choose a drug that has a good track record—in other words—do you prefer one of the older, rather than newer, biologics? These are all things to consider because if you choose what suits you best, you will more likely remain compliant with your treatment.

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  • Maini RN and Venables PJW. "Patient information: Rheumatoid arthritis treatment" UpToDate.