Biologic therapies can reduce the progression of rheumatoid arthritis (RA), but they cannot cure it. Additionally, they might have less adverse effects than other types of drugs.

Rheumatoid arthritis (RA) is treated using a class of medications called biological response modifiers. To address joint damage, your doctor might advise you to begin as soon as possible after your diagnosis.

Your doctor may prescribe a biologic in addition to or instead of the anti-rheumatic medication methotrexate. Many people find that using a biologic along with methotrexate helps them manage their RA.

To find out more about the many available biologics, possible adverse effects, and further choices, continue reading.

Available biologics

The mechanism of action of biologic DMARDs (bDMARDs) is to target immune system pathways.

They frequently block a variety of inflammatory substances, receptors, and cells, including CD80/86, c-reactive protein (CRP), interleukin-6 (IL-6), and interleukin-1 (IL-1).

The following bDMARDs are among the medications in this class that the FDA has approved for rheumatoid arthritis:

• tocilizumab (Actemra)
• sarilumab (Kevzara)
• anakinra (Kineret)
• abatacept (Orencia)
• rituximab (Rituxan)

The body naturally produces tumor necrosis factor-alpha or TNF alpha. People with RA may experience an increase in it, leading to pain and edema.

TNF-alpha inhibitors aid in preventing this TNF rise. TNF-alpha inhibitors are also included in biologic DMARDs, including:

• certolizumab pegol (Cimzia)
• etanercept (Enbrel)
• adalimumab (Humira)
• infliximab (Remicade)
• golimumab (Simponi)
• golimumab (Simponi Aria)

Biosimilars are classified as either bDMARDs or TNF-alpha inhibitors and are sufficiently similar to existing biologics to yield comparable outcomes.

The following biosimilars are used to treat RA:

• etanercept-szzs (Erelzi)
• etanercept-ykro (Eticovo)
• adalimumab-bwwd (Hadlima)
• adalimumab-fkjp (Hulio)
• adalimumab-afzb (Abrilada)
• adalimumab-atto (Amjevita)
• infliximab-axxq (Avsola)
• adalimumab-adbm (Cyltezo)
• adalimumab-adaz (Hyrimoz)
• infliximab-dyyb (Inflectra)
• infliximab-abda (Renflexis)

Some of these medications take effect fast. Others might not be fully effective for weeks or months. Not everyone reacts well to the same medicine, and each person uniquely reacts to these drugs.

A biologic may be sufficient for certain individuals. You might, however, require a biologic in addition to a different class of medication, like methotrexate. It has been demonstrated that biologics work well when used in conjunction with another type of treatment.

How are biologics given?

Biologics are often administered by injection. A few are administered subcutaneously. Some need to be injected straight into a vein.

How do biologics for RA work?

The way biologics function is by blocking immune system signals that cause inflammation and joint tissue damage.

The protein known as TNF was the target of the first class of biologic that was authorized for use in the treatment of RA. These medications, which block particular stages of the inflammatory process, are known as anti-TNF biologics.

They have an impact on immune system function even if they don’t completely inhibit the immune system like traditional DMARDs do.

Methods

Because biologics target particular mediators of RA inflammation, they may be more effective than traditional DMARDs in managing the progression of RA in certain individuals. The body reacts differently to these more recent biological medications.

Some of these medications interfere with the inflammatory process by directly affecting T-cells or B-cells, or they can interfere with certain chemical signals that contribute to inflammation.

Tumor necrosis factor (TNF), a crucial protein of the immune system, is inhibited by many biologics.

Side effects of biologics for RA

Any medication that suppresses the immune system contains dangers, but biologics may have fewer adverse effects than other kinds of medications.

An elevated risk of infection is a typical adverse effect. Multiple sclerosis and lymphoma are examples of more severe side effects.

Long-term biologic usage, however, does not raise the risk of infection in RA patients, according to a 2017 study.

The degree of inflammation in autoimmune arthritis patients has been linked to a higher risk of lymphoma.

More research is necessary, though, as a more recent study has indicated that these drugs might not raise the risk of cancer.

The advantages of managing RA exceed the dangers for many people who also have other hazards.

Any unexpected symptoms you experience, such as a fever or other symptoms you are unable to explain, should be reported to your doctor.

Biologic medications may not be safe for those with liver illness. Consult your physician about the safety of biologics if you have liver problems.

Other non-biologic solutions

Another therapeutic option you may want to think about is Janus-associated kinase (JAK) inhibitors. They are consumed as pills.

Among the JAK inhibitors are:

• Upadacitinib (Rinvoq)
• Olumiant (baricitinib)
• Xeljanz (tofacitinib)
• Filgotinib

Takeaway

RA can be treated using a family of medications called biologics. Compared to other treatment choices, they may have fewer adverse effects and help halt the progression of RA by reducing bone erosion and joint degeneration.

Consult your physician if you would like to try a biologic for RA. With your specific needs in mind, they will be able to advise you on the best course of action.

It’s crucial to discuss any side effects you have with your doctor if you’re taking biologics.