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How Biologic Drugs Are Given for Rheumatoid Arthritis

By

Chris Iliades, MD

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PHYSICIAN CONTRIBUTOR

Treatment Options for RA

There's no one-size-fits-all approach to treating RA. It’s important to work closely with your physician.
Doctor preparing injection needle

Biologic drugs are a newer type of very effective treatment for rheumatoid arthritis (RA). They've been used since 1998 in more than 600,000 people. Most people treated with biologics respond well and note an improvement in their symptoms. If you have moderate to severe RA that has not responded to other RA drugs, your doctor may want you to try a biologic drug.

These drugs are called biologics because they act like natural substances made in your body. When you have pain and swelling from RA, signalling substances made by your body called cytokines make things worse. Biologic drugs are man-made proteins that block the effects of cytokines.

Biologic drugs can be used alone or with other RA drugs called disease-modifying anti-rheumatic drugs (DMARDs). A common DMARD used with biologics is methotrexate. You may also continue to take a corticosteroid drug (prednisone) or a nonsteroidal anti-inflammatory drug (NSAID) while using a biologic. NSAIDS include both over-the-counter drugs, such as aspirin and ibuprofen, as well as prescription forms, such as celecoxib (Celebrex).

Taking Biologics for RA

Many drugs, such as prednisone and pain relievers, that you may have taken for RA have probably been in pill form. One of the differences of most biologics is that they are given by injection into your skin or vein. Injection under your skin is called a subcutaneous injection. Some drugs have to be taken slowly. A slow, drip-type injection directly into your bloodstream through a vein is called an intravenous (IV) infusion.

Tofacitinib (Xeljanz) is the first FDA-approved oral biologic for RA. It is taken in pill form twice a day. Janus kinase (JAK) enzymes signal several important cytokines to cause inflammation in RA. Tofacitinib prevents JAKs from signaling those cytokines.  

These biologics are given by injection:

  • Adalimumab (Humira) is injected once every one or two weeks. Humira comes in both prefilled syringes and in an autoinjection system that looks like a pen. You may have a rash, burning and itching at the injection site. These reactions may last up to one week.

  • Anakinra (Kineret) is injected once every day and at the same time each day. Kineret comes in prefilled syringes. It causes injection site reactions in two-thirds of people. These reactions may last for a few weeks.

  • Certolizumab (Cimzia) is given in two injections once every two weeks for the first few doses and then every four weeks. Cimzia also comes in prefilled syringes.

  • Etanercept (Enbrel) is injected once or twice a week. Enbrel comes in both prefilled syringes and in an autoinjection form. Injection site reactions with Enbrel are usually mild.

  • Golimumab (Simponi) is injected once a month in your thigh. Simponi comes in both prefilled syringes and in an autoinjection system. You may have redness in the area that was injected and mild dizziness.

These biologics are given by infusion:

  • Abatacept (Orencia) is given every two weeks for the first three doses and then every four weeks. The IV can be given at an infusion center or at your doctor's office. The infusion takes about 30 minutes. You may have headache, nausea, dizziness, or back or leg pain following your infusion. Tell your doctor if the symptoms are severe or last longer than expected.

  • Infliximab (Remicade) is given every four to eight weeks. The IV can be given at an infusion center or at your doctor's office. The infusion takes about two to three hours. You may experience chills, aches and fever afterward. These symptoms may be reduced by slowing down the infusion or taking an antihistamine beforehand.

  • Rituximab (Rituxan) is given every two weeks and takes several hours to administer. The infusion can be given at an infusion center or at your doctor's office. You may have chills, fever, headache and nausea after your infusion.

  • Tocilizumab (Actemra) is given every four weeks and takes about an hour. The IV can be given at an infusion center or at your doctor's office. You may have a runny nose, sneezing, and headache during or after your infusion.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Apr 22, 2017

© 2016 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

View Sources

Medical References

  1. Rheumatoid Arthritis Treatment. Johns Hopkins Arthritis Center. https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-treatment/
  2. Certolizumab Injection. MedlinePlus, U.S. National Library of Medicine. https://medlineplus.gov/druginfo/meds/a608041.html
  3. Abatacept Injection. MedlinePlus, U.S. National Library of Medicine. https://medlineplus.gov/druginfo/meds/a606016.html
  4. Rituximab Injection. MedlinePlus, U.S. National Library of Medicine. https://medlineplus.gov/druginfo/meds/a607038.html
  5. Golimumab Injection. MedlinePlus, U.S. National Library of Medicine. https://medlineplus.gov/druginfo/meds/a610010.html
  6. Tocilizumab Injection. MedlinePlus, U.S. National Library of Medicine. https://medlineplus.gov/druginfo/meds/a611004.html

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