Biologics

Biologic response modifiers, or biologics, are a group of medications that work by blocking the actions of chemicals that are part of the immune system, called cytokines. One type of cytokine is tumour necrosis factor alpha (TNF-α). High levels of TNF-α have been found in the affected joints of people with ankylosing spondylitis (AS). TNF-α is believed to send signals leading to joint inflammation and damage. By blocking TNF-α, the biologics listed below can help treat AS.

Biologics available in Canada for AS include:

• adalimumab (Humira®)
• etanercept (Enbrel®)
• golimumab (Simponi®)
• infliximab (Remicade®)

Adalimumab (Humira®):

• What does it do? Adalimumab is used to reduce the signs and symptoms of AS. It is used when people have not responded to other therapies.
• How do I use it? Adalimumab is given as an injection under the skin (subcutaneous injection) every 2 weeks. It is available in a pre-filled syringe or a pre-filled pen. Once they have been properly trained by their doctor, people can self-inject the medication at home once every 2 weeks.

Etanercept (Enbrel®):

• What does it do? Etanercept is used to reduce the signs and symptoms of AS.
• How do I use it? Etanercept is given as an injection under the skin once or twice a week. It is available in a pre-filled syringe or as a multiple-use vial where the medication must be prepared using sterile water before it is injected. People can be trained by their health care provider to give themselves the injection at home.

Golimumab (Simponi®):

• What does it do? Golimumab is used to reduce signs and symptoms of AS. It is used when people have not responded to other therapies.
• How do I use it? Golimumab is given as an injection under the skin once a month using a prefilled syringe or prefilled auto-injector.

Infliximab (Remicade®)

• What does it do? Infliximab is used to reduce the signs and symptoms and improve physical function for people with AS. It is used when people have not responded to other therapies or are intolerant to other therapies.
• How do I use it? Infliximab is given as an injection into a vein over a period of 2 hours (this is called an intravenous infusion). A dose is given 2 weeks after the first dose, 6 weeks after the first dose, and then every 6 to 8 weeks thereafter. Infusions are given by a health care professional, either at a hospital or at a specialized clinic. People cannot self-inject the medication at home.

The side effects depend on the medication used. The most common side effects of biologics include nausea, abdominal pain, headaches, injection-site-related reactions (pain, itching, swelling), upper respiratory infections (e.g., bronchitis, cold, sore throat), or infusion-related reactions (rash, flushing, or headache).

Serious side effects include severe allergic reactions, serious infections including tuberculosis and sepsis (a bacterial infection that spreads throughout the body), blood problems (e.g., decreased number of blood cells), malignancies, and nervous system disease (with symptoms including numbness, tingling, and vision problems).

Before prescribing these medications, your doctor will discuss all other side effects with you. If you have an active infection, your doctor may decide to hold off starting treatment. Also, if you develop a new infection while taking biologics, you should contact your doctor immediately.

Your doctor may recommend regular blood tests and checkups while you are taking biologics. Ask your doctor what side effects you should watch out for and which ones need to be reported to your doctor.

Biologics can often be given when other medications are also being used to treat AS, such as corticosteroids, NSAIDs, and pain relievers.

Talk to your doctor for more information on treating AS with biologics.