What do they do?
Biologics are medications genetically engineered from a living organism, such as a virus, gene or protein, to simulate the body’s natural response to infection and disease. The body naturally produces small amounts of these agents, but when produced in large amounts in the laboratory and given by injection or infusion, biologics can interfere with different inflammatory substances, cells or pathways responsible for the symptoms and damage of rheumatoid arthritis and some other inflammatory forms of arthritis.
How do they work?
The biologics used in arthritis treatment work in one of several ways:
- by blocking a protein called tumor necrosis factor, which is made by white blood cells and promotes inflammation of joint damage
- by blocking white blood cells called B-cells which produce antibodies and are produced excessively in in some forms of arthritis
- by blocking interleukin-1 (IL-1) or interleukin-6 (IL-6), two proteins involved in joint inflammation
- by inhibiting the activation of white blood cells called T-cells, thereby preventing the chain reactions that result in inflammation.
Who are they for?
Biologics are usually reserved for people whose disease has not responded well to other medications such as NSAIDs or DMARDs. All of the drugs in this chart, with the exception of belimumab (Benlysta), are approved for rheumatoid arthritis. Adalimumab (Humira) and etanercept (Enbrel) are also approved for ankylosing spondylitis, polyarticular juvenile idiopathic arthritis (JIA) and psoriatic arthritis. Golimumab (Simponi) and infliximab (Remicade) are also approved for ankylosing spondylitis and psoriatic arthritis, and abatacept (Orencia) is also approved for JIA. Belmumab is approved only for lupus.
What’s important to know about the drug class?
Biologics will not cure RA or other conditions, but for many people they can induce remission. A clinical remission is defined as fewer than 15 minutes of morning stiffness and no tender or swollen joints for at least three months. Treating rheumatoid arthritis and other inflammatory forms of arthritis aggressively with DMARDs, including biologics, as soon as possible after diagnosis increases the chance of remission, as well as minimizes the risk of limited function due to permanent joint destruction.
If you want to try a biologic, your doctor will likely start with one of the five TNF inhibitors or tocilizumab (Actemra), an agent that blocks interleukin-6 (IL-6). Both are approved for patients whose disease not responded adequately to traditional disease-modifying drugs. If the first biologic fails to control your disease, your doctor may switch you to a(nother) TNF inhibitor. Some people have to try a few or more biologics until they find the one that works best for them. You should never take two biologics together, because limited research suggests that doing so would greatly risk the risk of infection, without an increase in the drugs’ therapeutic benefit.
Because biologics suppress the immune system, they may increase the risk of infections and certain cancers. If you have a serious or recurrent infection, you should not start a biologic. You should also avoid live vaccines while taking one.
Drug Guide: Biologics
These genetically engineered medications control the immune response.
What do they do?
Biologics are medications genetically engineered from a living organism, such as a virus, gene or protein, to simulate the body’s natural response to infection and disease. The body naturally produces small amounts of these agents, but when produced in large amounts in the laboratory and given by injection or infusion, biologics can interfere with different inflammatory substances, cells or pathways responsible for the symptoms and damage of rheumatoid arthritis and some other inflammatory forms of arthritis.
How do they work?
The biologics used in arthritis treatment work in one of several ways:
- by blocking a protein called tumor necrosis factor, which is made by white blood cells and promotes inflammation of joint damage
- by blocking white blood cells called B-cells which produce antibodies and are produced excessively in in some forms of arthritis
- by blocking interleukin-1 (IL-1) or interleukin-6 (IL-6), two proteins involved in joint inflammation
- by inhibiting the activation of white blood cells called T-cells, thereby preventing the chain reactions that result in inflammation.
Who are they for?
Biologics are usually reserved for people whose disease has not responded well to other medications such as NSAIDs or DMARDs. All of the drugs in this chart, with the exception of belimumab (Benlysta), are approved for rheumatoid arthritis. Adalimumab (Humira) and etanercept (Enbrel) are also approved for ankylosing spondylitis, polyarticular juvenile idiopathic arthritis (JIA) and psoriatic arthritis. Golimumab (Simponi) and infliximab (Remicade) are also approved for ankylosing spondylitis and psoriatic arthritis, and abatacept (Orencia) is also approved for JIA. Belmumab is approved only for lupus.
What’s important to know about the drug class?
Biologics will not cure RA or other conditions, but for many people they can induce remission. A clinical remission is defined as fewer than 15 minutes of morning stiffness and no tender or swollen joints for at least three months. Treating rheumatoid arthritis and other inflammatory forms of arthritis aggressively with DMARDs, including biologics, as soon as possible after diagnosis increases the chance of remission, as well as minimizes the risk of limited function due to permanent joint destruction.
If you want to try a biologic, your doctor will likely start with one of the five TNF inhibitors or tocilizumab (Actemra), an agent that blocks interleukin-6 (IL-6). Both are approved for patients whose disease not responded adequately to traditional disease-modifying drugs. If the first biologic fails to control your disease, your doctor may switch you to a(nother) TNF inhibitor. Some people have to try a few or more biologics until they find the one that works best for them. You should never take two biologics together, because limited research suggests that doing so would greatly risk the risk of infection, without an increase in the drugs’ therapeutic benefit.
Because biologics suppress the immune system, they may increase the risk of infections and certain cancers. If you have a serious or recurrent infection, you should not start a biologic. You should also avoid live vaccines while taking one.
