Biologic response modifiers, also known as biologics, comprise the newest class of rheumatoid arthritis medications. They are designed for people with moderate to severe rheumatoid arthritis who have not responded well to other medications. Most biologics work by blocking a chemical called tumor necrosis factor, which is thought to cause inflammation in the joints.
Anti-tumor necrosis factor agents are the most common type of biologic. They include etancercept (Enbrel®), infliximab (Remicade®), golimumab (Simponi®), adalimumab (Humira®), and certolizumab (Cimzia®).
Other biologics, which work by inhibiting other molecules that cause inflammation, include abatecept (Orencia®), tocilizumab (Actemra®), rituximab (Rituxan®), and tofacitinib citrate (Xeljanz®).
Biologics can be prescribed on their own or in conjunction with other disease-modifying antirheumatic drugs, such as methotrexate, for people with severe symptoms.
At this time, Xeljanz® is the only biologic that can be taken by mouth. Most biologics are given by injection—anywhere from weekly or twice a week to once a month. Your doctor or nurse can teach you how to give yourself the injection at home.
Other biologics, such as infliximab, are administered through a vein with intravenous (IV) infusion or through a needle or a catheter. This is done at an infusion center in your doctor’s office every few weeks and can take up to three hours. You are able to read, rest, or watch television while receiving the infusion.
Common side effects include skin reactions, such as redness or irritation at the injection site.
These medications affect your body’s ability to fight infection and should not be used if you have a chronic infection, such as tuberculosis. Most people are tested for tuberculosis before starting a biologic. After that, they are tested annually, because the medication can reactivate the illness in a person who has been exposed to tuberculosis.
People with rheumatoid arthritis who have recently had cancer should also avoid biologics, as should people with systemic lupus erythematosus, multiple sclerosis, or congestive heart failure.