What Are Biologics for Rheumatoid Arthritis?
Biologics are medicines made from living cells. They belong to a class of drugs called disease-modifying antirheumatic drugs (DMARDs). They treat rheumatoid arthritis (RA) by targeting specific molecules involved in the inflammation process.
Biologics for rheumatoid arthritis were first introduced in the 1990s and have become a widely accepted option for treating RA because of how well they reduce symptoms and keep the disease under control, as well as how effective and safe they are for long-term use.
Why Take Biologic Drugs?
Although popular medications for treating rheumatoid arthritis, such as nonsteroidal anti-inflammatory drugs (NSAIDs), help reduce pain and inflammation, biologics work against the inflammatory proteins that cause your symptoms, promote inflammation, and hurt your joints.
Biologics reduce how serious your symptoms get over time, improve how well your joints work, reduce your need for other medicines, and improve your quality of life. These medicines are often recommended when other conventional DMARDs don’t work as well as they should in treating rheumatoid arthritis.
Who Should Take Biologic Drugs for Rheumatoid Arthritis?
Doctors often prescribe biologics to help you manage symptoms if you have previously tried conventional synthetic DMARDs such as methotrexate but did not get the expected health benefits.
Health guidelines recommend that your doctor will only consider biologic drugs for you if you have moderate symptoms and have tried and not responded to methotrexate and another DMARD after taking them for at least 6 months unless you can’t take these medications for other health concerns.
Types of Biologics for Rheumatoid Arthritis
There are several types of biologics for rheumatoid arthritis. They include:
B-cell inhibitors block B cells, which are white blood cells that carry a protein that involved in triggering your immune response.
Interleukin-1 (IL-1) blockers stop the production of an inflammatory chemical your body makes.
Interleukin-6 (IL-6) or interleukin-17 blockers stop inflammatory chemicals from attaching to your cells.
Selective co-stimulation modulators block T-cell activity in your body.
T-cell inhibitors block communication between T cells, a type of white blood cell important for your immune system.
Tumor necrosis factor (TNF) inhibitors block a chemical your body makes that drives the inflammation process.
Biologic Drugs for Rheumatoid Arthritis
The FDA has approved these medications to treat rheumatoid arthritis. You might take a biologic alone or with another arthritis drug. As a general rule, you shouldn't take different biologic therapies at the same time.
Abatacept (Orencia). This medication is a selective co-stimulation modulator. It works by blocking T cells. You get it in a shot every week or by IV (in your vein) once a month. The most common side effects include headache, cold symptoms, sore throat, and nausea.
Adalimumab (Humira), adalimumab-adaz(Hyrimoz), adalimumab-adbm (Cyltezo), adalimumab-afzb (Abrilada), adalimumab-atto (Amjevita), adalimumab-bwwd (Hadlima), adalimumab-fkjp (Hulio). These medications target tumor necrosis factor (TNF). You get them as a shot once every 1-2 weeks. The most common side effects are cold symptoms, sinus infection, headache, and rash.
Anakinra (Kineret). This medicine targets interleukin-1 (IL-1). You take it as a shot once a day. The most common side effects are pain or skin reactions in the area where you get the shot, cold symptoms, headache, and nausea.
Certolizumab (Cimzia). This biologic targets tumor necrosis factor (TNF). You take it as a shot every 2-4 weeks. (Your doctor will decide how often you get it.) Its most common side effects are the flu or a cold, rash, and urinary tract infections.
Etanercept (Enbrel), etanercept-szzs (Erelzi), etanercept-ykro (Eticovo). This medication also targets tumor necrosis factor (TNF). You take it as a shot 1-2 times each week. The most common side effects are skin reactions or pain where you get the shot, sinus infections, and a headache.
Golimumab (Simponi, Simponi Aria). These biologics target tumor necrosis factor (TNF). You'll take Simponi as a monthly shot and Simponi Aria every 8 weeks by IV. The most common side effects are:
- Runny nose
- Sore throat
- Hoarseness or laryngitis
- Pain, skin reactions, or tingling at the injection site
- Viral infections such as the flu and cold sores
Infliximab (Remicade), infliximab-abda (Renflexis), infliximab-axxq (Avsola), infliximab-dyyb (Inflectra), infliximab-qbtx (Ixifi). This medication targets tumor necrosis factor (TNF), and you take it by IV. Your doctor will decide on the dose and recommend that you take it 2 weeks after your first dose, then after 6 weeks. The most common side effects are respiratory infections (such as sinus infections and a sore throat), headache, coughing, and stomach pain.
Rituximab (Rituxan). This medication targets B cells. You take it as an infusion by IV. Your first two infusions will be 2 weeks apart. You can repeat the infusions every 6 months. The most common side effects are reactions to the infusion, chills, infections, body aches, tiredness, and a low white blood cell count.
Tocilizumab (Actemra). This medication targets interleukin-6 (IL-6). You can take it by IV once a month or every two months. Or you can get shots every week or every other week. The most common side effects are a cold, sinus infection, headache, high blood pressure, or liver problems.
Side Effects of Biologics
Biologics generally have similar side effects. The most common are pain and rash where you got the shot. But they affect only a small number of people who take these drugs. Biologics can cause allergic reactions. Because some go directly into a vein, you'll get the infusion at a place where your doctor can keep an eye on you. Reaction symptoms include:
- Flu-like illness
- Fever
- Chills
- Nausea
- Headache
Severe side effects of biologics
As with any drugs that suppress your immune system, biologics can make you more likely to get infections and other diseases. See the doctor if you have a fever or unexplained symptoms. You may need to get vaccinations to prevent infections before you start a biologic. Talk to your doctor before getting a vaccination if you're on a biologic.
Other severe side effects of biologics include:
- Vision problems
- Swelling of the feet and hands
- Shortness of breath
- Heart failure
- Risk of diseases such as hepatitis B and tuberculosis (TB) becoming active again
Who Shouldn’t Take Biologics for Rheumatoid Arthritis?
Your doctor will tell you whether or not it's safe for you to take biologics for rheumatoid arthritis. In general, you should avoid biologics if you have any of the following:
- Active infections
- Low white blood cell count (leukopenia)
- Certain blood cancers, skin cancers, kidney, liver, or heart conditions
- Immunodeficiency disorders, which lower your body's immune response
- Demyelinating diseases such as multiple sclerosis
- Previous history of TB, hepatitis B or C unless treated and then only with caution
What Are Biosimilars?
A biosimilar is very similar to, but not an exact copy of, a biologic drug. You'll know that your medication is a biosimilar if it has a dash after the generic name, followed by four letters.
Biologic drugs are harder to make than conventional medicines. While most traditional meds are made from chemicals and have known structures, biologics are more complex. They're typically made from living materials, such as animals, humans, and bacteria cells.
It's not possible to make a perfect copy of a biologic drug, because each drugmaker uses different cells and a different process to make each drug. That's why biosimilars are a little different from the original drug.
Drugmakers have to prove that biosimilars are just as safe and effective as the original and that they work the same way. You get the same dose the same way at the same strength.
Biologic drugs are much more expensive than other medicines. Even with health insurance, your out-of-pocket costs may add up to hundreds or even thousands of dollars every month.
Experts believe biosimilars may bring down the cost. Once the patent on a biologic drug runs out, other companies can make their own versions. These biosimilars usually come with lower price tags. The hope is that this will help more people get the drugs they need.
The FDA has approved 44 biosimilars, as of November 2023. The drugs below can treat rheumatoid arthritis, although only a few are available on the market:
- Biosimilars of infliximab (Remicade): infliximab-axxq (Avsola), infliximab-qbtx (Ixifi), infliximab-dyyb (Inflectra), and infliximab-abda (Renflexis)
- Biosimilars of etanercept (Enbrel): etanercept-ykro (Eticovo) and etanercept-szzs (Erelzi)
- Biosimilars of adalimumab (Humira): adalimumab-afzb (Abrilada), adalimumab-atto (Amjevita), adalimumab-adbm (Cyltezo), adalimumab-bwwd (Hadlima), adalimumab-fkjp (Hulio), and adalimumab-ad az (Hyrimoz)
Biosimilars work as well as biologics and carry no extra risks or side effects. Biosimilars that are safe to swap are called interchangeable biological products. The FDA is finalizing guidelines regarding these products for drugmakers.
Takeaways
Biologics are another option for treating rheumatoid arthritis if conventional medications haven't been effective. They can be used alone or with other arthritis drugs to reduce inflammation, slow joint damage, protect joint health, and manage symptoms. However, they can be expensive and have serious side effects.
Your doctor may not recommend them if you have health conditions, such as multiple sclerosis. Before starting biologics, talk to your doctor about other options. Also, inform your doctor if you have any worrying side effects while using biologics.
Biologics for Rheumatoid Arthritis FAQs
How safe are biologics for rheumatoid arthritis?
Biologics are generally safe for treating rheumatoid arthritis but may reduce how well your immune system works and increase your risk of infections.
What is the newest biologic for rheumatoid arthritis?
Sarilumab is the newest biologic for treating rheumatoid arthritis.
Do biologics for RA cause hair loss?
Biologics such as TNF inhibitors may cause hair loss in rare cases.
