Biologic medications are drugs that target specific parts of your immune system to treat disease.
If you have a condition like psoriatic arthritis, biologics can make a big difference. They can ease inflammation in your body, stop joint damage, and improve your quality of life.
But these powerful drugs can also have serious side effects.
What Are Biologic Drugs?
Biologics, also called biologicals, are drugs made from living things. Sometimes, these substances come from human donors, such as donated blood. Other times, they are grown in a laboratory. For example, scientists might grow a type of bacteria that makes a helpful substance. Then, they harvest and purify the substance to use it as medicine. The substance is usually a type of protein, but it could also be sugar, nucleic acids, or a combination of multiple substances.
There are many different types of biologics. Popular ones include:
- Vaccines
- Gene therapies
- Donated blood and blood products such as plasma
- Monoclonal antibodies
- Transplanted tissues, such as in skin grafts
- Insulin
- Stem cell therapy
- Immunosuppressants
- Disease-modifying antirheumatic drugs (DMARDs)
These medicines are given as a shot or through an infusion into a vein.
Biologics can treat a variety of conditions, such as cancer, psoriasis, rheumatoid arthritis (RA), and inflammatory bowel diseases such as Crohn’s disease. In the future, they could treat even more conditions, including ones that are currently untreatable. Every day, scientists are learning more about how biologics can save lives.
How Do Biologic Medications Work?
Every biologic medicine works a little differently. A few examples are:
- Vaccines. These expose your immune system to a dead or weakened virus. Your immune system learns how to recognize the virus so it can protect you from it in the future.
- Donated blood. This is given to people who have lost a lot of blood or who have blood disorders. The healthy blood replaces the lost or diseased blood.
- Gene therapy. This treatment introduces new, healthy genes into your body. The healthy gene copies can help replace damaged or missing genes.
- Insulin. If you have diabetes, you can inject this hormone. It helps deliver glucose throughout your body.
- Monoclonal antibodies. These help your immune system to identify, track down, and destroy cancer cells.
- Tumor necrosis factor (TNF) inhibitors. These drugs, such as adalimumab (Humira), calm down your immune system. They do this by blocking TNF, a protein that causes inflammation.
Biologic Medication Side Effects
The side effects of biologics usually depend on the type of medicine you use.
Common side effects of biologic drugs include:
Injection or infusion reactions. You may have a skin reaction where the shot went in, especially when you’re just starting treatment. This might include:
These things should go away on their own. Tell your doctor if they get worse or last longer than five days.
Some people who get infusions of biologic medicines may have a mild or serious reaction.
Symptoms of a mild reaction can include:
Serious reactions are rare but may include:
- Trouble breathing
- A severe allergic reaction
- Chest pain or tightness
- Fever or chills
- High or low blood pressure
- Swelling of the face and hands
Nausea. Biologic drugs can upset your stomach.
Headaches. Headaches are more common in people who use biologic drugs.
Infection. Biologic meds raise your risk of infection because they weaken your immune system. You could get a cold, a sinus infection, an upper respiratory tract infection, bronchitis, or a urinary tract infection (UTI). One study found that people who take these drugs may also be more likely to test positive for COVID-19.
Reactivation of infections. A biologic medicine can cause the return of conditions such as hepatitis B or tuberculosis (TB) if you’ve had them before. Your doctor will test you for these infections before you start treatment.
Fatigue. For most people, biologics help treat the fatigue that often comes with an autoimmune condition. But in some, the tiredness may get worse or even continue after you stop taking the drug.
Rarer Side Effects of Biologic Drugs
Here are some rarer side effects of biologics:
Central nervous system issues. These include sudden vision problems, numbness, or tingling.
Heart problems. Things such as shortness of breath or sudden heart failure are possible.
Lupus-like syndrome. This condition can start as a rash that affects your face and arms and gets worse when you’re in the sun.
Cancer. Older studies found that people who took biologic medicines might be more likely to get lymphoma. More recent research shows no link. But some studies suggest that biologic medicines may slightly raise your risk of certain types of skin cancer.
Liver problems. Biologic medicines may cause a change in how your liver works. Symptoms of liver issues include yellowing of the skin or eyes.
New joint pain. Though biologics are used to treat arthritis, they can sometimes cause new joint pain.
How Common Are Side Effects of Biologic Medications?
The chances of side effects depend on the type of biologic drug you use, how long you use it, your medical history, and how your body responds to the drug.
One study looked at 1,000 people who took a biologic medication and another 1,000 who got a placebo. In the biologic group, 770 reported a side effect, which was slightly more than the 724 in the placebo group who reported side effects.
The researchers also found that 127 of 1,000 people who received a biologic reported a serious side effect, compared with 118 of 1,000 who took a placebo.
How to Manage the Side Effects of Biologic Drugs
There are ways to manage, or even prevent, many of the side effects of biologic drugs:
- Good hygiene can help you avoid infections when you have a weakened immune system. Wash your hands often, try to avoid crowded places when you can, and stay away from sick people to lower your risk.
- If you notice a mild injection site reaction, try a cold compress, an antihistamine medicine, a steroid cream, or acetaminophen to ease the discomfort.
- To prevent more serious reactions, your doctor might suggest that you take an antihistamine, antiemetic, or anti-inflammatory medicine before your treatment.
- If you have nausea, medicines can help. Or you can suck on ice chips, sip cool water, inhale the scent of peppermint, or drink ginger tea.
- To ease a headache, put a cold compress on your forehead for 10 to 15 minutes. You can also take a warm shower or sit quietly in a dim room for a few minutes.
Talk to your doctor if the side effects are affecting your daily life or if you have severe symptoms.
Who Should Not Take Biologics?
Although biologics can be very helpful for certain diseases, they can occasionally cause harmful side effects. In general, these include:
- Infections. Some biologics are immunosuppressants, which means they calm down your immune system. This is great for diseases where the immune system is overactive, such as rheumatoid arthritis. But it also means that your weakened immune system is more vulnerable to infections. If you have a chronic infection such as hepatitis B, a biologic could reactivate it.
- Immune responses. Because biologics are made by living things, they might look to your immune system like an invading germ. This could cause an immune response such as an allergic reaction. You might notice redness and itchiness where the shot went in and shortness of breath.
- Central nervous system symptoms. Biologics can affect your nervous system, causing symptoms such as trouble seeing, numbness, and tingling.
- Heart problems. If you have an existing heart or lung condition such as chronic obstructive pulmonary disease, biologics could cause a bad reaction. You might notice swelling around your ankles or hands or shortness of breath. In severe cases, heart failure may occur.
- Lupus-like syndrome. Some people have noticed symptoms such as a rash on their face and joint pain after starting biologics.
If you’re already taking biologics and notice any of these signs, talk to your doctor immediately.
Every biologic is different and has different side effects and warnings, which decide who can safely take the drug.
For example, you shouldn’t take a type of biologic called DMARDs if you:
- Have an infection
- Have a low white blood cell count
- Don’t have enough stem cells in your bone marrow
- Have certain blood cancers
- Have certain kidney, liver, or heart conditions
- Have an autoimmune problem
Before starting biologics, ask your doctor if you are at risk for any complications. Talk about the risks of specific drugs and discuss your options. Your doctor can help you decide whether a biologic drug may be right for you.
How Much Do Biologic Medications Cost?
Biologics are hard to make, so they tend to cost more than regular drugs. On average, a biologic costs about $10,000 to $30,000 per year, although the most expensive ones can cost more than $500,000.
Insurance can help pay for biologics. However, some insurance companies may choose which biologics they do and don’t cover. Regardless of which drug you get, you’ll probably need prior authorization from your insurance. You'll likely need to pay a proportion of the cost, called coinsurance. For example, on average, people with rheumatoid arthritis pay about $2,700 in coinsurance through Medicare Part D before reaching catastrophic coverage.
Biosimilar Medications
Biologics can be expensive. If you’re looking for a more affordable alternative, a biosimilar drug might be a good choice. A biosimilar drug is almost exactly the same as the biologic version. It works the same way and is just as effective. But it costs about 20%-30% less.
Biosimilars are like generic drugs because they're cheaper versions of brand-name drugs. But technically, biosimilars are not generics. While generic and brand-name drugs have identical active ingredients, it’s impossible to make an identical version of a biologic drug. Biologic drugs are made from living things, so they’re much more difficult to copy. Because of this, biosimilar drugs have tiny differences from biologic drugs. But these differences don’t affect how the drug works.
If you’re concerned about the cost of a biologic drug, ask your doctor if a biosimilar option is available.
Weighing the Risks and Benefits of Biologics
It’s a good idea to read the information packet that comes with your biologic medicine. This has a full list of possible side effects and reactions to watch for.
You may see something called a black box warning, which means the medication has serious safety risks. This sounds scary, but it’s important to remember that all medicines carry some risks.
Your doctor will consider all the risks and benefits when deciding on a prescription. If they suggest one that has a black box warning, it’s because they think it will be more helpful than harmful.
Talk with them if you want to know more or if you’re worried about side effects.
Takeaways
Biologic medications are drugs made from living things. They are considered cutting-edge treatments for a variety of conditions, but they can also cause some side effects. Talk with your doctor about whether a biologic or a biosimilar (a more affordable alternative) is right for you.
Biologic Medications FAQs
What is considered a biologic drug?
A biologic drug is one that’s made from a living thing. Vaccines, donated blood, gene therapy, and monoclonal antibodies are examples of biologic drugs. Many are made from bacteria in a lab.
What is the most common biologic drug?
Humira (adalimumab) is a popular biologic drug. It’s a type of TNF inhibitor.
What do biologics do to your body?
Biologics can treat many diseases, including cancer and rheumatoid arthritis. But they also can increase your risk for infections and other side effects.
What is the difference between a biologic and a chemical drug?
Most biologic drugs, such as donated blood, are large and complex mixtures made from living things. Chemical drugs are smaller, more simple, and can be made directly by scientists.
Which biologic drug is the safest?
It depends on the condition and your personal health history. Talk with your doctor about which biologic is the best for you.
