Arthritis Care Center Oklahoma

Rheumatoid Arthritis

Biologics for Rheumatoid Arthritis

Biological products are a relatively new class of drugs used for the treatment of rheumatoid arthritis (RA). They are considered a type of disease-modifying antirheumatic drug (DMARD).

Biologics differ from standard medications in that they are derived from proteins created by living cells. (Conventional drugs are chemicals synthesized in a laboratory.)

All biologics have been demonstrated to improve physical function in clinical studies. There are several biologics approved to treat rheumatoid arthritis, including:

  • Abatacept (Orencia®)
  • Adalimumab (Humira®)
  • Anakinra (Kineret®)
  • Certolizumab (Cimzia®)
  • Etanercept (Enbrel®)
  • Golimumab (Simponi®)
  • Infliximab (Remicade)
  • Rituximab (Rituxan®)
  • Tocilizumab (Actemra®)
  • Tofacitinib (Xeljanz®)

Biologics are also more expensive than conventional treatments. However, the evidence so far is that they work well and pose fewer risks than other systemic therapies.

Biologics must be given either by injection or by intravenous infusion (IV). An IV infusion requires visiting the office or infusion center for 30 minutes to several hours per session. However, the advantages of these drugs are significant.

In general, two biologic medications are not recommended for use at the same time.

Types of Biologic Medications for RA

Biologics target a specific part of the immune system, instead of the whole immune system. This focus reduces the likelihood of side effects.

Different biologic medications works in different ways.

Tumor Necrosis Factor Inhibitors (TNF Inhibitors)

  • Certolizumab (Cimzia®), etanercept (Enbrel®), adalimumab (Humira®), infliximab (Remicade®), and golimumab (Simponi®).

TNF inhibitors reduce inflammation by blocking tumor necrosis factor (TNF), a cytokine or immune system protein that triggers inflammation during normal immune responses. These medication are highly effective for treating patients with an inadequate response to DMARDs. They may be prescribed in combination with some DMARDs, particularly methotrexate. 

Possible side effects with etanercept include pain or burning in throat; redness, itching, pain, and/or swelling at injection site; runny or stuffy nose. Possible side effects with infliximab include abdominal pain, cough, dizziness, fainting, headache, muscle pain, runny nose, shortness of breath, sore throat, vomiting, wheezing. Possible side effects with adalimumab include redness, rash, swelling, itching, bruising, sinus infection, headache, nausea.  

Interleukin-1 Inhibitors

  • Anakinra (Kineret®)

These agents work by blocking a cytokine called interleukin-1 (IL-1) that is seen in excess in patients with rheumatoid arthritis. This medication requires daily injections. Long-term efficacy and safety are uncertain. Side effects include redness, swelling, bruising, or pain at the site of injection; headache; upset stomach; diarrhea; runny nose; and stomach pain. Doctor monitoring is required.

Interleukin-6 (IL-6) Receptor Inhibitors

  • Tocilizumab (Actemra®)

IL-6 receptor inhibitors works by blocking the activity of interleukin-6, a substance in the body that causes inflammation. Tocilizumab is injected intravenously (into a vein). It is usually given once every 4 weeks.

CD20 antibody

  • Rituximab (Rituxan®)

CD20 antibodies stop the activation of a type of white blood cell called B cells. This reduces the overall activity of the immune system, which is overactive in people with rheumatoid arthritis. This medication is for people whose rheumatoid arthritis has not responded to other biologic agents. It is usually given by two IV infusions 2 weeks apart. It is given with methotrexate.

Selective costimulation modulator

  •   Abatacept (Orencia®)

Selective costimulation modulators block a particular chemical that triggers the overproduction of white blood cells called T cells that play a role in rheumatoid arthritis inflammation. Abatacept is given intravenously in a 30-minute infusion. It may be given alone or with DMARDs.

JAK Inhibitors

  • Tofacitinib (Xeljanz®)

Tofacitimib belongs to a new class of drugs call jak kinase (JAK) inhibitors, fights inflammation from inside the cell to reduce inflammation in people with rheumatoid arthritis.  It is formulated as a pill that is taken twice daily. It works by blocking molecules called “Janus kinases,” which are important signals in the development of joint inflammation that occurs with RA.

What Are the Side Effects of Biologics?

Biologic medications are relatively new, and some of the long-term effects are not yet known. Your physician will want to regularly monitor your health while using them.

As with any drugs that suppress the immune system, biologic therapy might pose some risks, since they can make your body more vulnerable to infections and other diseases. For instance, biologics may cause some chronic diseases, such as tuberculosis, to flare up. And biologics are not recommended for people with multiple sclerosis and other conditions ,such as congestive heart failure. 

Possible side effects include increased risk of pneumonia, and listeriosis (a foodborne illness caused by the bacterium Listeria monocytogenes). It is important to avoid eating undercooked foods (including unpasteurized cheeses, cold cuts, and hot dogs) because undercooked food can cause listeriosis for patients taking biologic response modifiers.

Patients should seek immediate medical attention if they develop persistent fever.