20 Facts about Biologic Medications for Rheumatoid Arthritis
Biologic response modifiers or Biologics are a modern class of medications which are used to treat autoimmune diseases such as Rheumatoid Arthritis. Often Biologics are distinguished from “drugs” which are chemically synthesized medicines. Biologic medications are used to interfere with the treacherous immune system response of Rheumatoid Arthritis.
Truths about Biologic medications for RA
- Biologics were designed to treat cancer and autoimmune diseases.
- Biologics, like vaccines, are made from living organisms.
- Biologics can help slow or delay Rheumatoid Arthritis damage.
- Some studies show Biologics can make the course of RA milder.
- Many countries have not approved the use of Biologics due the expense to state run health care.
- Biologics work better with methotrexate.
- It can take over 10 years and over 1 billion dollars to bring a new biologic drug to market. (Estimated at over 1.2 billion in 2007.)
- Patients can develop antibodies against Biologics, making them ineffective. Methotrexate can help prevent this.
- There are about 10 different Biologics that have already been approved for use with various autoimmune diseases.
- Biologics are injected because harsh digestive enzymes can ruin them.
- It can take several months for a Biologic to reach its potential benefit.
- Biologics may need to be suspended in case of infection or surgery, but not for every cold virus.
Myths about Biologic medications for RA
- You should wait to use Biologics until other DMARDs have failed to achieve remission.
- Biologics help all Rheumatoid Arthritis patients live normal lives.
- Only patients with severe RA should use Biologics.
- Biologics are just expensive anti-inflammatories.
- Biologics cause cancer. (This may not be true; however, RA can increase cancer risk.)
- Biologics make you gain weight. Prednisone, on the other hand… EDIT: A subsequent study showed 1 biologic might influence leptin and therefore weight gain. This myth might be busted!
- Biologics cause infections.
- All Biologics work in the same way.
Recommended reading:
- Pyramid Approach to Rheumatoid Arthritis Trashed
- The Four Courses of Rheumatoid Arthritis, part 1
- My Journey with Rheumatoid Arthritis Medicine
- How well do Biologic medications help Rheumatoid Arthritis?
This is such an important topic. I wish they had been around when I was diagnosed in ’71, so much of the damage to my joints happened in the first few years.
It took a long time for me to even think about trying them. Have used Remicade, Enbrel, Rituxin and now Humira. I’m taking Humira with Arava (lefluonomide) as after many trials on mthx I refuse to take it again. Humira helped, but when you’re on steroids it’s hard to tell.
I know it sure doesn’t make it the full 2 weeks. Do others have that poop out problem? I like the convenience of being able to take my own shot, thankfully needles never bothered me. I trained as a nurse, but never practiced. And I’d just as soon stick myself rather than a nurse that’s having a bad day. I use the syringe instead of the pen, as the pen is too clumsy for my hands.
The art of a shot is to make sure the alcohol has dried, or it will burn like fire as you drag it in along with the needle. The second part is get the needle in fast. Don’t prolong it by easing it in.
I was scared to death to try these drugs and I will never be entirely comfortable with them. But if they are suggested by a fully qualified doc, give them a try. It may be your saving grace in preventing damage that may or may not be reversed by surgery.
Ah Kelly, I’m as usual so wordy, great post, love the picture.
Nanc, I know many report that Humira ( and others ) are their wonder drugs. So, my experience is probably out of the mainstream. My dr increased my Humira to weekly doses (double) in an attempt to get more out of it. Using it weekly, there were about 2 “better” days per week, but those days represented about 50% improvement. I’m not sure how long you’d have to be on the regimen before the dr increased the dose – probably an individual thing based on his judgement. I find it hard to fill needles, but I do it for the mtx. Does that Humira come prefilled?
Thank you for the compliment on the photo – this one was taken by my daughter. I’ll pass it on.
Good Morning – Humira does come in pre-filled syringes. I remember trying to fill mthx. syringes, not easy anymore. Hope to see my Mayo doc in about 2 months, at which time we’ll discuss weekly use. My body is sooooo wierd, I don’t know if he’ll let me.
Hi Kelly – I am wondering where your source is for the statement that many countries have not approved biologics because of the cost. What countries would those be? I know many, Australia, Canada, the UK and the Netherlands, all have approved biologics, and at least Australia has approved them as a first step, without the need to fail DMARD’s?
Even the Enbrel website says there is an increased risk of lymphoma with using Enbrel. Also, Simponi even says so in their commercial. The drug companies put that info out there as there is a risk.
Hi Leslie, yes I know that has to be reported by them since lymphoma incidence has been noted. There has never been proof that Enbrel “causes” cancer, only higher incidence. The patients had another thing in common though: RA. The link in the post is to one study which says that it’s not Biologics, but RA that is behind the slightly higher incidence of lymphoma. No concrete proof either way – but RA on it’s own takes several years off of lifespan. Here’s a link to a few posts on RA and death.
I wouldn’t say “only” higher incidence as a way to make it sound better. A higher incidence of lymphoma by taking a medicine is very serious. The warnings on these drugs list the chances of getting lymphoma or other cancer increases with taking that drug.
simponi website
enbrel website
lawsuit filed
Sorry if I confused you. I meant a different use of “only” than that. Not to say only as unimportant, but only as in solely. Correlation does not ever prove causality. That’s all I meant.
Did you read the article liniked in the post? The post says it “may not be true that Biologics cause cancer. Here’s another article which explains what I’m saying: click here.It is a balanced discussion with several good points.
I have read studies that say RA itself double the risk of lymphoma. It’s still small, but it’s significant when you are trying to figure out whether the medicines cause cancer.
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🙂 thanks. i’m trying to push my doctor to explore more aggressive treatment, so I’m getting all the information i can!
I have been on Embrel for over three years, and although I have had to make many modications in the way that I do things and have pain 24/7, it is in no way as severe as before Embrel started working for me, and at least I have a life. It is not the life I had before RA (that is gone forever), but it sure beats the heck out of the life I had after RA hit me like a freight train. I also have an autoimmune liver disease that was confirmed by a biopsy several months after the RA diagnosis, so no more MTX for me. Anyway, about the same time that Embrel started working, my liver enzymes started going down into the high normal range. Has anyone else had this happen to them? I really believe that Embrel had something to do with this, and have told my rhummy, but of course she couldn’t really say yea or nay because no studies have been done that she is aware of. I won’t give up Embrel to be part of a study, but I would definitely consider participating in a study to see how people on Embrel and people who are not who have primary biliary cirrhosis. Does anyone know how to go about checking into something like this. If Embrel really is helping to slow down another autoimmune disease, this medicine could help extend the lives of at least some people with this disease. Terrible about some countries with state run health care not approving biologics because of the expense. Do they really think supporting people who can no longer work, providing in home care, paying nursing home care, etc. for disabled people is cheaper?
Good point about cost-effectiveness of treatment Charlene. I know – that bothers me too. Biologics are not availble or limited in many places – still.
Sorry about the incomplete sentence-serious case of brain fog. I would like to know if Embrel makes a difference in the progession of primary bilary disease or not.
Hi Kelly, long time no post from me..mainly because i’ve been feeling so much better from being on Embrel, (with small dose of mtx) but also because i have now set up my own page (UKAAG) on Facebook with a friend who has PSA, of which i believe you have ‘liked’! And this takes up a bit more time – but other than that i am thankfully living my life.
As far as Embrel and cancer is concerned, my rhuemy nurse described it as ‘Embrel won’t CAUSE cancer, but if one was going to get cancer, whether taking an Anti TNF or not, then because the person taking the Embrel has had the immunity ‘switched off’ that might help to fight that cancer, then it is more likely that this cancer will possibly develop. But ONLY if that person was going to get it anyway.’ But she did advise that if there were any scans offered, then take them, and just to be ‘aware’ of any changes in your body that aren’t ‘normal’. (which we should be doing anyway).
This made me feel better about taking it, as we do all know that the long term risk effects of RA far out weighs the risks from the Anti TNF. I hope it helps others with their decision in whether to take it or not.
Lotslv and carry on with your brilliant work!
Sara x
Kelly…I am wondering what the relationship is between Biologics and infections…I see you listed the relationship between Biologics and infections as a myth…I would love to learn more? Where may I find the information?
I don’t think I’d put it that way. I was just saying that they don’t cause infections as I’ve heard some say they do. But it’s believed that they can make your body less able to fight an infection if you have one. I wish I’d made that more clear in the list.
I have often talked about preventive first aid behaviors to avoid infection if we take any immunosuppressive – even prednisone. I don’t know of any study that proves the exact relationship and docs vary about how much concern they have about infection with these drugs. Personally, I’d withhold them in case of infection in the future – I’ve had several docs who did otherwise, but I now believe that was wrong. I’m sorry if I was confusing. Bad late night editing.
Adding to what Sara said about Enbrel and cancer, my oncologist told me today that TNF blockers such as Humira, etc. are NOT recommended for cancer survivors. This is not the saying they cause cancer, of course, but that if you have already had cancer, then the TNF blockers are categorically to be avoided. Sorry I don’t have pertinent medical details to offer, but I do trust my oncologist and he acknowledges that it is a difficult balancing act to have severe RA and be a cancer survivor too.
Indeed Mary, which is precisely what i was saying..it makes perfect sense for a cancer survivor to NOT be recommended with an Anti TNF, as that person is already at risk or open to maybe another possible cancer forming.
But for those who are fortunate to be cancer-free, Anti TNF is as safe, (but can carry some possible risks), as its going to be for the next cancer-free person, as for myself, it’s effects on RA seem to outweigh any risks that there may or may not be.
Medicare will has stopped their approval of rituxan, anybody out there know where I can go to get this covered or funded?
Been going round and round with insurance over the Rituxan infusions and Medicare paying. I’m told because I’m seronegative I’m coded differently. And with this code Medicare will NOT pay. If you have a secondary insurance, I’m told (and certainly hope this is correct) that the secondary insurance will pay. If it is a supplemental insurance to Medicare it will NOT pay. Since I just had my first infusion last week, I haven’t had this proven as yet but surely hope I was given correct information.
Thank you for fact/myth sheet. I am on third new biologic trying to discontinue MTX may not be possible in my case. Still hoping…..we can’t ever stop hope!
ALSO since we’re talking about biologic meds….Kelly…have you or anyone else out there heard of Humira causing Psoriasis???
Jeannie Shirk, yes Humira did cause me to have psoriasis all over my body. Never had it before I started Humira. It started after my 3rd. injection along with hives and hair loss. It’s been almost 1 year I’ve been off Humira and I still have psoriasis on my scalp. Dermatologist did 4 biopsies on my skin in 4 different places and they showed that I was allergic to Humira. Needless to say I will never use that poison drug again. Now I’m on MTX and hoping it will help with my pain. I even sent in a complaint to the FDA re: side effects of Humira. If we have side effects from any drug, we should complain to the FDA so they will know that a drug is not that safe for everyone.
Im 42 and was diagnosed at about age 30. I have tried all different types of biologics. Humira, Enbrel, Simponi, back to Enbrel. I thank God for it everyday. My fingers had started to shift & deform prior to starting biologics. I know if it wasn’t for my medicine I would be even more deformed. I still have pain. . Don’t get me wrong and I complain on the daily. But it is pain that I can deal with. I notice the difference during times that I am sick and don’t take my Enbrel that my pain becomes much worse. Do I worry about the side effects, of course I do.. but I pray that with our blood test that we do if something else comes up we will be able to catch it early and work on that.
Have been on Humira for 2 years. Did pretty good on this but retired in Dec. Medicare won’t pay for it. Started Cimzia shots T Drs. Office in March. Having trouble with IBS. Just wondering if anyone else had this problem?
Biological definitely make you gain weighthe. I always struggled with gaining a ton of weight on biologics, and I don’t take prednisone or any other steroids. Just visit a support forum for any biologic and you’ll see tons of people struggling a lot with weight gain.
I am struggling with weight gain -taking Simponi Aria.
Does anyone have any helpful tips to lose weight?
The struggle is real! I have reduced calories and began to walk again.
Is anyone successful?
Thank you in advance!
I have been on Simponia for about a year. The first several months it did no good, but then I read that it will most likely take a few months for it to reach its potential. I am finally starting to feel a bit better, however, in the past 2 months, I have started to gain weight. An alarming amount (for me) I am only 5′ 1′ and have put on 15lbs.
I have also joined a gym, I work out 3-5 days a week and walk my dogs 3 mi every night. (yoga, swimming, and water aerobics) I’ve also eliminated “most” carbs and desserts. I’ve added lots of fresh fruit/veggies as it is summer. This weight is ALL in my stomach, I am so uncomfortable I just want to scream! It’s awful, as I’ve never been overweight in my life it is affecting me adversely.
I told my R.A. doctor last night, she said she doubts it’s the meds. Even though she looked at my weight for the entire 4 years I’ve had R.A. (it is the exact same except for 1 lb up or down). So I said, “then why have I gained so much (remember I’m only 5’1′) in such a short period of time?” She had no answer or help, she told me I could cut out corn (carbs) even though I had already told her I’ve done so! Then she said in a barely nice voice, well I can’t do anything so go off the meds if you want too. She didn’t offer the idea of trying a different biologic, just go off if you don’t like it.
I’m really upset, both with her attitude and lack of offering any advice. (stop eating corn) So I’d like some advice from all of you. Has anyone esle had this happen or am I nuts?
Thanks, I apprecaite the help
Dear Jody,
I’m so sorry! I’ve been through it from steroids, even while I starved, so I know how maddening it is.
There are some studies that show tnf inhibitors (simponi is one) can affect leptin and then cause weight gain. You could consider changing meds unless it works so well that you don’t want to…
Another idea – thyroid problems are common in people with RD. So if you can find a great endocrinologist, you could try a small supplement of t-4 or t-3 (or increase it if you already take thyroid meds). This is the most directly linked problem for metabolism.
And… of course I HATE that so many docs are so dismissive. It’s true it’s a hard job & there are no easy answers. But kindness should not be so difficult.
I ended up with Lymphoma from mtx, all clear now, granted I had cancer 4 times in my life, but be careful and stay on top of your labs
My rheumy put me on Humira. (after I had tried mtx, enbrel and xeljanz.) After the 3rd injection my hair started falling out, I got psoriasis all over my body (never had it before), hives all over and itching so much I couldn’t live with it. I stopped the humira, told my rheumy and he said to stop all meds for RA. Went to dermatologist for psoriasis and he took 4 different biopsies at different times and in different places and sent them to labs and it came back that I was allergic to Humira. This was a totally horrible experience for me. It’s been a year since the last injection of Humira and I still have psoriasis and itching. This was poison to me and is taking over a year to get out of my body. Humira is poison, beware all.