Are Biologic Treatments Right For You?

These medications are potent weapons against rheumatoid, psoriatic and other forms of inflammatory arthritis. Here’s a primer.

Lori Murray
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Biologic medications are potent weapons in the fight against inflammatory arthritis, especially rheumatoid arthritis (RA). And if you have moderate to severe RA, there’s a good chance your rheumatologist may discuss using a biologic at some point during your therapy. The question is: When is biologic treatment right for you?

To help guide you when talking with your doctor, we asked Scott Zashin, MD, a Dallas-based rheumatologist and clinical assistant professor at the University of Texas Southwestern Medical Center, to shed light on these common questions.

What are biologics?
Biologics are protein-based drugs made from living cells cultured in a laboratory. They are relatively new options in the treatment of inflammatory arthritis, including RA, psoriatic arthritis and ankylosing spondylitis (spinal arthritis). Unlike traditional RA drugs that are made by a chemical process and affect the entire immune system, biologics target specific actions of the immune system.

Am I a good candidate for biologic treatment?
You may be if your current treatment isn’t working well enough. This is the most common reason for starting a biologic, says Dr. Zashin, especially if you’re already taking another disease-modifying antirheumatic drug (DMARD) like methotrexate. Signs that your treatment isn’t working:

  • Blood tests show you still have signs of active disease. These include having a high erythrocyte sedimentation rate (ESR) or high levels of C-reactive protein (CRP).
  • X-rays show you have joint damage.
  • You continue to have swollen and tender joints.
  • You have morning stiffness that lasts 45 minutes or more.
  • You still have pain or fatigue that’s interfering with daily activities.
  • You can’t take other arthritis medications. Side effects and other concerns—such as birth control issues or wanting to become pregnant—may rule out the use of methotrexate and other nonbiologics. If so, your rheumatologist may recommend a biologic instead.

What should I know before starting a biologic?
You may need treatment with more than one drug.
Although some people do well with one medication (called monotherapy), others need to take two or more (called combination therapy). “About 80% of patients using biologics also take methotrexate or some other DMARD,” says Dr. Zashin. And if you’re having flare-ups during treatment, your doctor might recommend painkillers or anti-inflammatories.

You may need to be tested for certain infections. Many people who have been exposed to tuberculosis or certain fungal infections don’t know it. These infections need to be treated before you start taking any drug that affects the immune system, including a biologic.

You’ll need a primer on how to take your medication. Biologics must be given by injection or intravenous (IV) infusion. Why? In a word: Digestion! Because biologics are man-made versions of natural proteins, if the drug were swallowed, digestive enzymes would break it down before it ever reached the targeted parts of the immune system. Therefore, the best way to deliver biologics is by injection or IV infusion directly into the bloodstream.

What should I expect during treatment?
Expect the best! “Many people notice improvement after one dose, but it can take up to six months to get the full benefits,” Dr. Zashin says.

Keep your doctor up to date. That means keeping all follow-up visits, since your doctor will want to monitor how your body is responding. Important: Tell your doctor if you have an infection, are scheduled to have surgery, have been diagnosed with another health condition (e.g., diabetes) or are due to have any vaccinations, since you should not receive certain vaccines made with live viruses. 

April 2013