Biologic Therapy as a Treatment for Rheumatoid Arthritis

Biologic therapy sounds a little like something from a science fiction novel. Although the technology is relatively new, it’s far from fictional or experimental. Biologic therapy has become a vital tool in the treatment of rheumatoid arthritis (RA) and other autoimmune diseases. These treatments relieve your symptoms and are known to prevent further joint damage in some cases.

How Does Biologic Therapy Work?

While most drugs are chemicals made in a lab, biologic therapies are different. Biologic therapies are actual copies of substances your body normally makes. Your body makes substances called cytokines (pronounced “sīto-kīns”). Cytokines are messengers that tell your immune system that something is wrong and it needs to react. In RA and other autoimmune diseases, your cytokines are out of control.They’re constantly telling your immune system to go full speed ahead. The end result is joint inflammation and destruction.

Biologic therapies, or biologic response modifiers (BRMs), work by suppressing your immune system. Some biologic therapies for RA do this by blocking the cytokines that are causing problems with your immune system. These cytokines are known as interleukin (pronounced “inter-lukin,” or IL) and tumor necrosis factor (TNF). The exact way biologic therapies block the cytokines differs slightly, but the outcome is similar—your immune system is suppressed. Other biologic therapies for RA block certain cells that make up your immune system. These are called B cells and T cells.

Biologic therapies (generic name first followed by brand name) for RA include:

  • Anakinra (Kineret) blocks IL

  • Tocilizumab (Actemra) blocks IL

  • Adalimumab (Humira) blocks TNF

  • Certolizumab (Cimzia) blocks TNF

  • Etanercept (Enbrel) blocks TNF

  • Golimumab (Simponi) blocks TNF

  • Infliximab (Remicade) blocks TNF

  • Rituximab (Rituxan) blocks B cells

  • Abatacept (Orencia) blocks T cells

What Can I Expect from Biologic Therapy?

Your doctor will recommend biologic therapy if other treatments have not worked. However, if you have severe RA, your doctor may recommend using biologic therapy earlier to stop further joint destruction. It’s common to use biologic therapies in combination with other treatments.

In most cases, you will notice improvement in your symptoms soon after starting biologic therapy. However, a full response may take up to four to six weeks.

What Are the Pros and Cons of Biologic Therapy?

Many doctors prescribe biologics earlier in the treatment of RA because of their known benefits including:

  • Significant symptom relief

  • Prevention of further joint damage

  • Prevention of long-term disability

  • Few and well-tolerated side effects

However, just about every medication has a downside and carries certain risks. RA biologics are known to make you more likely to get infections, some of which can be serious. Biologics can also cause certain chronic diseases to flare up.People with certain health conditions, such as multiple sclerosis or congestive heart failure should not use biologic therapy.

BRMs are not available in pill form because of how they are produced and how they must be absorbed into your body. A BRM requires an injection or intravenous infusion each time it is taken. This can pose a problem for some people. The cost of BRMs is also an issue. Biologics can cost over $12,000 a year in the United States. Their high cost is predominantly due to the manufacturing process.

Before starting biologic therapy, talk with your doctor about the side effects and risks. Together you can decide if the medicine is right for you.

Medical Reviewer: McDonough, Brian, MD; Last Annual Review Date: 1/30/2012 12:00:00 AM Copyright: © Copyright 2012 Health Grades, Inc. All rights reserved. May not be reproduced or reprinted without permission from Health Grades, Inc. Use of this information is governed by the HealthGrades User Agreement.