Rheumatoid arthritis (RA) is a type of inflammatory arthritis that causes the body’s immune system to attack healthy tissues lining the joints. Biologics are designed to fight the immune cells that attack these healthy tissues.
Although biologics do not help improve RA symptoms in every person, they do help approximately
The Food and Drug Administration (FDA) approved the first biologic drug to treat RA in 1998. Since then, the FDA has approved eight similar drugs, as well as a newer synthetic drug.
At their most basic level, biologics are proteins that scientists have genetically modified to make them target the immune system cells that attack healthy cells and cause RA symptoms. This can reduce the progression of joint damage from RA.
This means that biologics are a targeted form of therapy. In this way,
Biologics are not always the first line of treatment for RA. Many people with RA have problems in multiple cell types that cause symptoms, and biologics can target only one type of cell.
A doctor can prescribe only one biologic medication at a time because combined biologics can seriously compromise the immune system.
However, a doctor may combine a biologic with a traditional disease-modifying antirheumatic drug (DMARD). This can help the biologic medication stay effective longer and prevent the immune system from stopping its effect with neutralizing antibodies.
A person may find that it takes time to discover the combination that works best for their unique symptoms.
The American College of Rheumatology recommends that doctors prescribe biologics to people whose RA has not responded to other treatments in the way the doctor and patient have expected.
However, certain people should avoid biologics, such as the following:
- a person who has or recently had an active infection
- a person who has an active disease or condition such as tuberculosis, hepatitis B or C, cancer, diabetes, or heart problems — however, a person who has been treated for TB or hepatitis C may be able to restart treatment after the infection clears, and a person with hepatitis B can receive treatment to suppress the disease and may be able to take biologics under their doctor’s supervision
- a person who received a live vaccine less than 3 months before the planned start of treatment
- a person who is sensitive to latex or rubber — unless they take a latex-free biologic
If a person lives in an area with a higher risk of fungal infections, a doctor will need to monitor them while they are taking biologics, as they are more at risk of contracting the infection.
A person who is pregnant, considering becoming pregnant, or is breastfeeding or chestfeeding should also speak with their doctor about whether biologics are safe for them and their baby.
This chart lists the biologic medications available to treat rheumatoid arthritis, along with their recommended dosage. The next section goes into more detail about the different types of biologics.
|Certolizumab (Cimzia)||200 mg injection every 2 weeks|
|Etanercept (Enbrel)||50 mg injection every week or 25 mg injection twice per week|
|Golimumab (Simponi, Simponi Aria)||50 mg injection once per month|
|Infliximab (Remicade)||3 10 mg/kg through an IV every 4–8 weeks|
|Tocilizumab (Actemra)||162 mg injection every week or every 2 weeks, depending on a person’s weight, or 8 mg/kg through an IV every month|
|Sarilumab (Kevzara)||150–200 mg injection every 2 weeks|
|Rituximab (Rituxan)||2-course IV dose of 500–1,000 mg that repeats after 6 months|
|Abatacept (Orencia)||125 mg injection every week or 500–1,000 mg IV infusion every month|
|Anakinra (Kineret)||100 mg daily injection|
Doctors categorize biologic treatments according to which cells they target.
Categories of biologic treatments
B cell inhibitors
Example drug: Rituximab (Rituxan)
How they work: B cell inhibitors work by killing B lymphocytes that can cause inflammation. A healthcare professional must administer this medication intravenously (IV) for two sessions every 6 months. Each session lasts 4–6 hours. A person who receives B cell inhibitors via IV may be at risk for infection and transfusion reactions.
Example drug: Anakinra (Kineret)
How they work: Interleukin-1 blockers, or IL-1 blockers, target interleukin-1, an inflammatory compound in the body. Doctors prescribe this drug less often than other biologics for RA. A person must self-inject IL-1 blockers once daily.
How they work: These drugs prevent interleukin-6 proteins from attaching to cells and causing inflammation. Sarilumab is an injection that a person must receive every 2 weeks. A person can get tocilizumab via IV once or as an injection into the skin every week or every other week.
T cell inhibitors
Example drug: Abatacept (Orencia)
How they work: These medications attach to the surface of T cells, which are white blood cells that cause inflammation. Doctors administer the medication by IV for 30 minutes every month. A person then transitions to getting infusions every 4 weeks. A person can also get an injection into the skin once a week.
Tumor necrosis factor inhibitors (TNF-inhibitors)
How they work: These medications work by stopping the tumor necrosis factor, which is responsible for the beginning stages of inflammation. Doctors prescribe these drugs more frequently because they have the longest history as a treatment for RA. A doctor delivers infliximab via IV. A person can self-inject the other medications.
A person can take most biologic treatments either via IV infusion or by self-injection.
It is impossible to make these medications into a pill because the molecules they contain are too large to pass well into the blood from the gastrointestinal tract.
As a result, a method of delivery must place them directly into or very close to the blood. A doctor can discuss delivery methods as well as an infusion or injection schedule.
Some biologic treatments work very quickly after administration. Others may need significantly more time to take effect. In general, it takes 3–6 weeks to see initial results and about 3 months for the full effect.
In addition, biologics affect immune system cells. As a result, a person’s immune system may not be able to protect against infections as effectively.
Very rare side effects of biologic treatments include:
- demyelinating syndromes that damage nerve fibers, sometimes causing vision problems
- lupus-like syndrome development
- effects on liver enzymes
- reactivation of hepatitis B in people with a history of hepatitis B
- swelling of the hands and ankles, shortness of breath, or sudden onset of heart failure
A doctor should discuss the potential risks of each treatment. Some biologics have a higher incidence of infection than others.
The following are some answers to common questions about biologic treatments for RA.
Are biosimilars the same as biologics?
Biosimilars are a new type of medication that is very similar to biologic medications. Unlike generic drugs, they are not exact copies, but doctors can prescribe them to treat RA with similar effectiveness.
How much do biologics cost?
Biologic drugs for RA are expensive. A person’s out-of-pocket cost may vary depending on the drug and their insurance coverage, but the estimated overall cost is $22,000–44,000 per person each year.
What is the safest biologic for rheumatoid arthritis?
All biologics carry a risk of side effects such as infection. However,
What are other treatments for rheumatoid arthritis?
DMARDs and JAK inhibitors are other types of medication for RA.
Biologic treatments have helped many people with RA experience a reduction in symptoms and slow the progression of damage to affected joints.
Over the past decade, the number of available biologic treatments has increased. Researchers are studying many potential medications that may help people with RA in the future. Healthcare experts refer to these medications as new biologics.
Another promising field is personalized medicine, in which a doctor