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Biologics for rheumatoid arthritis treatment

In the last decade, there have been significant advances in treating rheumatoid arthritis (RA), especially for patients whose arthritis does not respond to traditional disease-modifying anti-rheumatic drugs (DMARDs). The most important advance has been the development of a class of drugs called biologic response modifiers or biologics.

There are a number of biologics approved to treat rheumatoid arthritis. These include:

  • Entanercept
  • Infliximab
  • Adalimumab
  • Certolizumab
  • Tocilizumab
  • Rituximab
  • Abatacept
  • Anakinra

Other biologics are being studied for the treatment of rheumatoid arthritis as well as other forms of arthritis.

How do biologics treat rheumatoid arthritis?

Biologics are genetically engineered proteins derived from human genes. They are designed to inhibit specific components of the immune system that play pivotal roles in fuelling inflammation, which is a central feature of several forms of arthritis.

Biologics differ significantly from traditional drugs used to treat rheumatoid arthritis, in that they target specific components of the immune system instead of broadly affecting many areas of the system.

What are the side effects of biologics?

As with any drugs that suppress the immune system, biologic therapy poses some increased risk of aggravating the body’s vulnerability to infections and other diseases. Patients taking biologics should seek immediate medical attention if they develop persistent raised temperature or unexplained flu-like symptoms. Vaccinations that prevent infections should be considered prior to administration of biologics. Patients should not receive live vaccines while taking biologic products.

Biologics may also cause some chronic diseases that are dormant (such as tuberculosis) to flare up, and they are not recommended for people with multiple sclerosis and other conditions such as congestive heart failure. All patients should be skin tested for tuberculosis prior to starting biologic therapy.

Since biologic therapy is still in the early stages of use, some of the long-term effects of these medications simply aren't known. Your doctor will want to monitor your health regularly while you are taking them. However, the evidence so far is that they work well, especially if DMARDs are ineffective or contra-indicated (a factor that makes taking the drug too risky).

One disadvantage of current biologic medications is that they must be given either by injection or by intravenous infusion.

Although animal studies of biologics have shown no effect on fertility or impairment of the foetus, these studies cannot always predict the effects in humans. Pregnant women should not be given these drugs.

Biologics are commonly discontinued before surgery, until wounds have healed and the risk of infection has passed.

As a general rule, different biologic therapies should not be taken at the same time.

Researchers say that future biologics, still in the early stages of development, may be less expensive and that some will be taken orally. Also on the horizon are biologics that target different areas of the immune system, providing new treatment options.

WebMD Medical Reference

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