8 Common Questions About Biologic Treatments

By

Beth W. Orenstein

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Injection

Just over a decade ago, a new class of rheumatoid arthritis (RA) drugs was introduced, making a dramatic difference in the prognosis of people with this potentially crippling disease. Here are answers to the most common questions about this exciting advancement in the treatment of RA.

What Are Biologics?

Most drugs are manufactured from man-made compounds. Biologics are different—human genes are used to make them in a laboratory. In the late 1990s, researchers developed biologics that are able to block the cells that trigger inflammation of the joints. Several biologics have been approved by the U.S. Food and Drug Administration for the treatment of RA. These include abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), and tocilizumab (Actemra).

How Are Biologics Given?

Most biologics must be injected under the skin. Working with the staff at the doctor’s office, most people can learn how to self-inject. How often you need an injection depends on which biologic you’re given. Injections generally range from daily to every two weeks.

What Are the Side Effects?

Most people find that they can tolerate the drugs quite well. You may develop a rash or experience burning or itching at the injection site. The rash could last for a week or more but should go away without any lasting signs. The most serious side effect is a higher susceptibility to infection, including tuberculosis, because biologics can lower your immunity. Your doctor will help you monitor any signs and symptoms of infection.

What Are the Benefits?

Most people who are given biologics report that they feel better after their first or second injection. Biologics don’t cure RA—there is no cure for RA at present—but they can slow the progression of the disease and reduce the amount of morning stiffness and tenderness you feel in your joints. They also can slow long-term damage to your joints.

How Much Do Biologics Cost?

Biologics are expensive. Most treatments cost at least $12,000 a year and some can reach as much as $30,000. They are expensive because they are made from live cells, which are costly to maintain, and have a more complicated production process. You may be able to get financial help to pay for your treatment.

Are All Biologics the Same?

All RA biologics are given for the same reason: To stop the inflammation that causes joint pain, swelling and damage. But they target different stages of inflammation. For example, adalimumab, certolizumab and etanercept prevent the production of a protein that is known to cause inflammation. Rituximab (Rituxan) targets the production of a type of white blood cell that causes the immune system to overreact. Your doctor may try different biologics to find the one that works best for you.

Can I Take More Than One Biologic at the Same Time?

No. Biologics work by suppressing your immune system. Your immune system protects you from diseases and infections. If you took more than one biologic, you could suppress your immune system so much that you could easily become seriously ill. Also, research hasn’t found any benefit of taking two biologics at once.

What Other Medications Will I Need?

Your doctor may recommend that you take another RA drug, methotrexate, with your biologics. This can both limit side effects of biologics and improve their effectiveness. Methotrexate is a powerful drug that also interferes with the activity of your immune system—the cause of RA’s painful symptoms. Some people who are given biologics find that they need to be on steroids and painkillers as well. Learn more about the benefits of combination therapy for RA.

Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Apr 10, 2015

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