A Sniper for Interleukin-6

How it works. Tocilizumab (Actemra) is an antibody that blocks the spot when interleukin-6 (IL-6) attaches to cells. IL-6 is an immune system protein that stokes inflammation, says Wei.

Makeup. Tocilizumab is a human monoclonal antibody.

Delivery. Tocilizumab is given intravenously for about an hour once a month. “Its manufacturer [Genentech] is now working on an [injected] formulation,” says Wei. 

In 2012, Genentech released results of SUMMACTA, a multicenter two-year study that found similar results between injections every two weeks compared with monthly intravenous forms of the drug.

Risks. Like other biologics, tocilizumab carries a risk of infection. In some patients, it raises liver enzymes and cholesterol, says Curtis. High liver enzymes may indicate liver damage or inflammation.

 

A Biologic Targeting B Cells

How it works. Rituximab (Rituxan) was first used to treat Non-Hodgkin's lymphoma, says Wei: “It wipes out B-lymphocytes, [a type of white blood cell] involved in inflammation.”

Makeup. Rituximab is a mix of mouse and human monoclonal antibodies.

Delivery. Rituximab requires two 4- to 6-hour infusions two weeks apart every six to 12 months, says Curtis: “That [schedule] is a convenience.”

Risks. A risk of infection.  “It also carries a higher risk for an infusion reaction like itching, a rash, or wheezing,” says Curtis.

 

Targeting T-Cells

How it works. Abatacept works by acting on T-cells [a type of white blood cell], says Wei. It attaches to the surface of inflammatory cells, blocking any communication between them.

Make-up. Abatacept is a fusion protein.

Delivery. Abatacept is given by a 30-minute infusion every two weeks for three doses, then every four weeks.

Risks. It carries the risk of infection.

 

Interleukin-1 (IL-1) Blocker

How it works.Interleukin -1 is a protein that is a major player in inflammation,” says Wei. Anakinra (Kineret) blocks the action of IL-1. However, says Wei, results from other drugs are stronger, so it isn’t used as frequently.

Makeup. Anakinra is a man-made form of a specific kind of protein secreted by the immune cells called Il-1 receptor antagonist, or IL-1Ra, which blocks IL-1. 

Delivery. It’s self-injected once a day.

Risks. Anakinra carries the usual risk of infection.

 

A Novel Class of Drug

How it works. Tofacitinib (Xeljanz) is one in a new class of drugs that inhibits Janus kinases, enzymes key to inflammation. It differs from other biologics because it targets RA from inside, not outside, the cells. But like biologics, it has a single target, the Janus kinases.*  

Makeup. “Unlike other biologics, it’s a small molecule drug, which enables it to be taken orally,” says Wei.

Delivery. The excitement: it’s a pill taken twice a day..

Risks. Along with a risk for infection, tofacitinib can increase liver enzymes and cholesterol, and raise the risk of shingles, a viral infection that causes a painful rash, says Curtis. “It’s quite different in that regard than the others.”