Biologics for rheumatoid arthritis
The good news is this...drug companies are opening their minds to the dangers of side effects. The bad news -- biologics are not quite there just yet, because they have been associated with adverse reactions including life-threatening infections and malignancies. A difference in biologic drugs versus most current medications is that they offer more than symptomatic relief -- they focus on underlying issues that cause symptoms. Three biologic agents -- etanercept (Enbrel), adalimumab (Humira) and infliximab (Remicade) are often effective in controlling RA in people who do not respond to conventional medications known as disease-modifying drugs (DMARDs). Enbrel, Humira and Remicade work by blocking a substance manufactured by the immune system called tumor necrosis factor (TNF). People with RA and related inflammatory diseases -- including juvenile rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and psoriasis -- have too much TNF in their bodies. This overwhelms the immune system's ability to control inflammation, resulting in painful, swollen joints or, in the case of psoriasis, redness, itching and thick, silvery scales on the skin. These medications are approved for RA, psoriatic arthritis, and ankylosing spondylitis. They are also used on an off-label basis for those inflammatory problems for which they are not approved. TNF-blocking biologics are essentially man-made versions of proteins that the body produces naturally whose job it is to bind to and deactivate TNF molecules before they can do their damage. This interrupts the chain of events that leads to some forms of inflammation, and much of its resulting pain and damage. Each of the three primary biologic drugs for RA (which are essentially blocking agents) have their pluses and minuses. A particular minus is that they can weaken the immune system... • Enbrel. Given by self-injection under the skin once or twice a week, Enbrel can provide rapid relief, often with the first shot. With both Enbrel and Humira, injection site reactions that include pain, redness and infections are a concern, and, as mentioned above, all three biologics can weaken the immune system. Alert your physician at the first sign of any infection. Another drug, Actemra, approved in August 2008 acts on interleukin-6 and shows much promise in rheumatoid arthritis. Other drugs on the horizen include Cimzia, a pegylated tnf-inhibitor and golimumab, another anti-tnf drug. Oral kinase inhibitors are being studied. These drugs have an entirely different mode of action and have the advantage of being able to be taken by mouth. As with any drugs that affect the immune system, biologics have a serious downside. Risks include... • Serious infections, including tuberculosis and sepsis RA can be a devastating, crippling disease, and some sufferers look on biologic medications as lifesavers. On the other hand, not everyone with RA needs to take biologics. These are serious drugs that should be used only when they are absolutely necessary, and some people may be able to get by with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and more natural treatments. Given that NSAIDs are also associated with bleeding gastritis, liver and kidney complications, many doctors encourage individuals to go natural first and save the drugs as a path of final resort. This is not necessarily the best approach though. The most important thing is to carefully individualize treatment. While one person with RA needs only NSAIDs, another might experience such rapidly developing damage that early and aggressive intervention with biologic medications is warranted. While biologic drugs are still used primarily for RA, they are also prescribed increasingly for other inflammatory diseases such as psoriasis, ulcerative colitis, Crohn's disease and psoriatic arthritis. As time goes on, more new biologic drugs will come on the market, and they may gradually become less expensive and able to be taken orally. Hopefully, they will be safer, as well.
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