July 24, 2014
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Arthritis (Rheumatoid)

 Health Home >> Arthritis (Rheumatoid) >> Treating RA and taking control 


Biologics

Biologic response modifiers, often called biologics, work by blocking the actions of the chemicals called cytokines, which are involved in attacking the lining of joints and tissues. Cytokines are messengers used by cells of the immune system to communicate with each other. Examples of cytokines involved in RA are tumour necrosis factor alpha (TNF-α) and interleukin (IL). In people with RA, inflammation of the joints occurs as a result of an imbalance between anti-inflammatory cytokines and the pro-inflammatory cytokines, IL and TNF-α, sending messages that lead to inflammation and tissue destruction.

Biologics help relieve the inflammation, swelling, and pain that accompany rheumatoid arthritis (RA). They are used for moderate to severe RA. Some biologics may be used alone or in combination with RA treatments (such as medications called DMARDs, or disease-modifying anti-rheumatic drugs).

Biologics used in Canada for RA include:

Some biologics (e.g., adalimumab, anakinra, certolizumab, etanercept, golimumab) are given at home and are self-injected under the skin (into the fat of your leg or abdomen) much like insulin for people with diabetes. You can learn to give yourself these injections at home (or have a friend or family member give the injection to you).

Abatacept (OrenciaTM)
  • What does it do? Abatacept is used to reduce symptoms, induce a major clinical response (i.e., relieve symptoms), slow the progression of joint damage, and improve physical function in adults with moderate to severe RA. It is used when people have not responded to other therapies (biologics or DMARDs). This medication can be used alone or in combination with a DMARD.
  • How do I use it? Abatacept is given as an injection into a vein over a 30-minute period. A dose is given 2 weeks after the first dose, 4 weeks after the first dose, and then every 4 weeks thereafter.
  • What are some known side effects? Abatacept can cause infusion-related reactions (headache, high blood pressure, dizziness, rash, flushing), headache, upper respiratory tract infections (e.g., bronchitis, cold), sore throat, nausea, and cough.
Adalimumab (Humira®)
  • What does it do? Adalimumab is used to reduce and improve symptoms, induce a major clinical response (i.e., relieve symptoms) and clinical remission of active RA, slow the progression of joint damage, and improve physical function in adults with moderate to severe RA. It can be used alone or in combination with methotrexate (or another DMARD).
  • How do I use it? Adalimumab is given as an injection under the skin every other week using a prefilled pen or a prefilled syringe.
  • What are some known side effects? Adalimumab can cause injection site-related reactions (pain, itching, swelling, fever), headache, upper respiratory tract infections (e.g., bronchitis, cold, sore throat), rash, nausea, diarrhea, abdominal pain, dizziness, and cough.
Anakinra (Kineret®)
  • What does it do? Anakinra is used to reduce symptoms and slow the progression of joint damage in adults with RA. It can be used alone or in combination with other DMARDs, such as methotrexate.
  • How do I use it? Anakinra is given as an injection under the skin every day using a prefilled syringe.
  • What are some known side effects? Anakinra can cause injection site-related reactions (pain, itching, swelling), headache, upper respiratory tract infections (e.g., bronchitis, cold, sore throat), nausea, diarrhea, and abdominal pain.

Certolizumab (Cimzia®)

  • What does it do? Certolizumab is used in combination with methotrexate to reduce symptoms, induce a major clinical response (to relieve symptoms), and slow the progression of joint damage in adults with moderate to severe RA. It can be used alone to reduce the symptoms of RA.
  • How do I use it? Certolizumab is given as an injection under the skin every other week using a prefilled syringe.
  • What are some known side effects? Certolizumab can cause injection site-related reactions (redness, rash, itching, bruising) and upper respiratory tract infections (e.g., flu, cold, sore throat).

Etanercept (Enbrel®)

  • What does it do? Etanercept is used to reduce symptoms, induce a major clinical response (i.e., relieve symptoms), slow the progression of joint damage, and improve physical function in adults with moderate to severe RA. It can be used alone or in combination with methotrexate.
  • How do I use it? Etanercept is given as an injection under the skin every week using a prefilled syringe or a prefilled auto-injector.
  • What are some known side effects? Etanercept can cause injection site-related reactions (pain, itching, swelling), headache, upper respiratory tract infections (e.g., bronchitis, cold, sore throat), weakness, mouth ulcer, dizziness, and rash.

Golimumab (Simponi®)

  • What does it do? Golimumab is used in combination with methotrexate to reduce symptoms in adults with moderate to severe RA.
  • 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.
  • What are some known side effects? Golimumab can cause injection site-related reactions (redness, rash, itching, swelling), headache, flu-like symptoms, upper respiratory tract infections (e.g., flu, cold, sore throat), tiredness, night sweats, weight loss, nausea, vomiting, and diarrhea.

Some biologics (e.g., abatacept, infliximab, rituximab, tocilizumab) are given as an intravenous (into a vein) injection in a hospital or clinic setting over a period of time (this is called an intravenous infusion), under the supervision of a trained health care professional.

Infliximab (Remicade®)
  • What does it do? Infliximab is used in combination with methotrexate to reduce symptoms, slow the progression of joint damage, and improve physical function in adults with moderate to severe RA.
  • How do I use it? Infliximab is given as an injection into a vein over a period of 2 hours or more (intravenous (IV) infusion). Doses are given at 0, 2, and 6 weeks, and then every 8 weeks.
  • What are some known side effects? Infliximab can cause infusion-related reactions (flushing, headache, fever), headache, rash, upper respiratory tract infections (e.g., bronchitis, cold, sore throat), abdominal pain, back pain, cough, diarrhea, dizziness, fatigue, and upset stomach.
Rituximab (Rituxan®)
  • What does it do? Rituximab is used in combination with methotrexate to reduce symptoms in adults with moderate to severe RA. It is used when people have not responded to other biologic therapies.
  • How do I use it? Rituximab is given as an injection into a vein over a period of 2 hours or more (intravenous (IV) infusion). Two doses are given 2 weeks apart.
  • What are some known side effects? Rituximab can cause infusion-related reactions (flushing, headache, fever, nausea, fatigue), upper respiratory tract infections (e.g., bronchitis, cold, sore throat), fever, shortness of breath, cough, skin rash, bleeding or unusual bruising, and indigestion.

Tocilizumab (Actemra®)

  • What does it do? Tocilizumab is used to reduce symptoms in adults with moderate to severe RA. It is used when people have not responded to other biologic therapies or DMARDs.
  • How do I use it? Tocilizumab is given as an injection into a vein over a period of 1 hour (intravenous [IV] infusion) every 4 weeks.
  • What are some known side effects? Tocilizumab can cause infusion-related reactions (flushing, headache, fever, nausea, fatigue), upper respiratory tract infections (e.g., bronchitis, cold, sore throat), cold sores, blisters, shingles, skin infection sometimes with fever and chills, high blood fats (cholesterol levels), headache, dizziness, high blood pressure, mouth ulceration, stomach pain, rash, and itching.

Biologics can cause serious side effects, including serious infections such as tuberculosis and sepsis (a bacterial infection that spreads throughout the body), severe allergic reaction, blood problems (e.g., decreased number of blood cells), and nervous system disease (with symptoms including numbness, tingling, and vision problems).

Biologics may also increase the risk of developing tumours and certain types of cancer. Rarely, people have developed cancer, including non-melanoma skin cancer and lymphoma (cancer that affects white blood cells in the lymph system). Very rarely, an often-fatal form of lymphoma called hepatosplenic T-cell lymphoma has occurred in people using some biologics along with other medication (azathioprine or 6-mercaptopurine). However, the exact link between this type of lymphoma and the use of biologics is not clear.

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.

Ask your doctor, nurse, or pharmacist about side effects to watch out for, and be sure you understand which side effects need to be reported and how quickly.

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