Biologics for rheumatoid arthritis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Biological response modifiers (biologics, for short), are a relatively new class of drug. These medicines are antibodies or parts of antibodies that are designed to target specific parts of the immune system, rather than the whole immune system. The ultimate aim is to control disease while minimizing side effects. These drugs have been in use for some time in the treatment of rheumatoid arthritis (RA), psoriatic arthritis, and ankylosing spondylitis.

While they are very effective, they have also been associated with adverse reactions including life-threatening infections and malignancies.

Biologics are used for controlling disease in people who do not respond to conventional disease-modifying drugs (DMARDs).

Some biologics such as Enbrel, Humira, Cimzia, Simponi, 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. This is an inflammatory protein that drives the autoimmune response in these various disease states.

TNF-blocking biologics bind to and deactivate TNF before it can do damage. This disrupts inflammation, and its resulting pain and damage.

A significant minus of these drugs is that they can weaken the immune system...

Other FDA approved drugs are tociluzimab (Actemra), abatacept (Orencia) and rituximab (Rituxan). These are second-generation biologics that work differently from TNF-blockers because they target a different part of the immune system. Actemra blocks the effects of interleukin-6, Orencia interferes with T-cell functioning, while Rituxan acts on B-cells.

Oral kinase inhibitors are close to FDA approval. 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, fungal infections, and sepsis
• Nervous system diseases, such as multiple sclerosis
• Blood problems
• Heart problems (for example, congestive heart failure)
• Allergic reactions
• Malignancies, including skin cancer and lymphoma

Longer-term effects of these drugs are not known.

While biologic drugs are still used primarily for RA, they are also prescribed 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.

More about biologics can be found on other pages on the site. If you're looking for a specific one, go to that page.

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Click here Second Opinion Arthritis Treatment Kit

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