Biologics for Rheumatoid Arthritis: Precision Therapy to Tame RA’s Fire
How Biologics Have Transformed Rheumatoid Arthritis Treatment
Slowing the progression of rheumatoid arthritis with biologic medications may mean staying active longer and avoiding surgery, among other benefits.
By Marie Suszynski
Medically Reviewed by Pat F. Bass III, MD, MPH
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Doctors have seen striking changes in the way rheumatoid arthritis (RA) progresses in people over the past 20 years, with a major driving factor being the arrival of biologic medications on the market.
“Change in the disease has really been dramatic,” says Brian D. Golden, MD, a rheumatologist at NYU Langone Medical Center in New York City. “There were no biologics at the beginning of my career almost 20 years ago and now there are many.” The results: “We don’t usually see people with end-stage crippling rheumatoid arthritis to quite the same extent that we used to,” he says.
There’s no doubt that biologic drugs have improved quality of life for people with RA, but they also carry some risks. Both the pros and cons should be considered before trying this newer kind of treatment for rheumatoid arthritis.
Treating Rheumatoid Arthritis With Biologics
The evidence that biologic medications are having an effect on RA can be seen anecdotally by doctors and in research. Some positives of the drugs include:
Improved everyday functioning.Rheumatoid arthritis can lead to joint deformities, particularly in small joints in the hands, wrists, and feet, says Anjali Casey, MD, a rheumatologist with NorthShore University HealthSystem in Skokie, Illinois. This can lead to trouble with everyday activities like writing, picking up a coffee mug, and opening jars. With biologic treatment, “we see that much less often, if at all,” Dr. Casey says.
Lower hospitalization rates.In the past, people with rheumatoid arthritis were often admitted to the hospital for rehabilitation because of severe joint damage, Dr. Golden says, but today he sees less of this. According to a study published in the journal Rheumatology in September 2014, the number of people with RA hospitalized for surgeries decreased dramatically in Ireland as prescriptions for tumor necrosis factor (TNF) inhibitors, a type of biologic drug, increased. The number of inpatient days for people with rheumatoid arthritis fell by nearly half, the study found.
Fewer surgeries.Research published in December 2014 in the American Journal of Pharmacy Benefits found that total knee and hip replacement surgeries among people with rheumatoid arthritis has declined. While the total number of hip and knee replacements among Americans spiked between 1993 and 2008, the number of people with RA who needed those surgeries dropped by nearly 30 percent after TNF inhibitors were introduced in the late 1990s and early 2000s.
More work hours. Several studies have looked at the effect biologic drugs have had on people’s ability to work, according to a February 2012 overview in the journal Rheumatology. Because biologics slow or even stop the progression of rheumatoid arthritis, people have less fatigue, are better able to function, and can continue working when they use this type of treatment, according to a March 2014 report in the journal BMC Medicine.
Higher rates of remission followed by a possible “drug holiday.”Biologic medications have helped a larger proportion of people with rheumatoid arthritis reach remission, which is leading researchers to study whether people should stop taking a biologic once they’ve achieved remission. According to a November 2014 report in the journal Drugs, research has shown that half of those with early RA can stop taking biologic drugs once they’ve reached remission without experiencing another flare.
The Drawbacks of Biologics
But even as experts hail the benefits of taking biologics for rheumatoid arthritis, there are some serious risks to be aware of. Because RA is an autoimmune disease, biologic drugs suppress the immune system, which leads to an increased risk for infection. “The infections to worry about most are tuberculosis (TB) and fungal infections,” Casey says. For that reason, people with active TB or ongoing fungal infections shouldn’t take biologics.
There’s also cancer risk to consider. On its own, rheumatoid arthritis can raise the risk for some cancers, including cancer of the lymph nodes (lymphoma), and there’s concern that biologic medications may boost the risk. An August 2012 report from the American College of Rheumatology Drug Safety Committee, however, looked at the research and concluded that biologics didn’t increase the risk for cancer except when it comes to people with a history of skin cancer (melanoma).
According to the report, a study of the British Society of Rheumatology Biologics Registry found that people with RA with a history of melanoma who took biologics were more likely to have a recurrence than were those given nonbiologic drugs.
Casey says that people with a prior risk for cancer should talk with their doctors about the potential benefits and risks of taking biologic drugs. Those who’ve had melanoma may want to avoid the biologics altogether.
Another drawback is that biologic drugs are expensive and insurance coverage varies, Golden says. However, if you can’t afford your prescriptions, many drug manufacturers offer financial assistance.
The bottom line is that many people with rheumatoid arthritis are candidates for treatment with biologics, Golden says, and these drugs are particularly recommended for people with markers of more aggressive disease.
Video: Side Effects of RA Biologics
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