The term biologic means a living thing. A biologic drug is a treatment made from a living thing or parts of a living thing. Most of the time, biologic drugs are created from antibodies. Antibodies are part of the immune (defence) system. They target viruses or bacteria causing illness, or other foreign agents that are not supposed to be in the body.
This special targeting ability makes biologic drugs unique. Using an antibody, these drugs can go straight to the disease without affecting healthy parts of the body. This helps reduce side effects.
Certain diseases are thought to be caused by an ‘overaction’ of the immune system. In diseases like rheumatoid arthritis, Crohn’s disease, and psoriasis, certain molecules in the immune system can get too high. This can cause damage. In rheumatoid arthritis, a molecule called TNF is found in the fluid surrounding swollen, painful joints. TNF is a natural part of the body’s immune system. However, when it gets too high, it damages areas like the joints.
Biologics can make a difference. Antibody drugs are created to specifically target TNF. The drug tracks down TNF, binds to it, and helps take it out of the body before it can do harm.
Three major diseases that can be treated with biologics are Crohn’s disease, rheumatoid arthritis, and psoriasis. All three have something in common — certain molecules are found to be too high in people having symptoms. The molecule TNF can be found in high amounts in the joints of people with rheumatoid arthritis. TNF is also overactive in people who suffer from Crohn’s disease. It makes sense that some biologics used in rheumatoid arthritis are also used to treat Crohn’s. Similarly, biologics for psoriasis target molecules called interleukins that help create thick, scaly growths on the skin. The medications find, attach to, and remove these molecules from the body, reducing symptoms.
Multiple sclerosis (MS) is another condition that can be treated with biologics. Some biologics, called beta interferons, are often used first for certain types of MS. Beta interferons help control the number and severity of MS attacks. Another biologic, glatiramer acetate (Copaxone®), reduces the stripping of the myelin sheath around the nerves, which causes MS symptoms. Several other biologics are used to treat MS (see chart). They are a very important part of relieving relapses of MS. Biologics are often combined with drugs that treat symptoms of MS, including muscle relaxants and drugs to help with tremor.
Approved In Canada To Treat
||SC||One to two times per week||RA, JIA, PsA, AS, psoriasis|
|Infliximab (Remicade®)||IV||Every six to eight weeks||RA, PsA, AS, psoriasis, CD, UC|
|Adalimumab (Humira®)||SC||Every two weeks||RA, JIA, PsA, AS, CD, psoriasis|
|Golimumab (Simponi®)||SC||Once a month||RA, PsA, AS|
|Certolizumab (Cimzia®)||SC||Every two to four weeks||RA|
|Anakinra (Kineret®)||SC||Once daily||RA|
|Rituximab (Rituxan®)||IV||Two doses, two weeks apart (average next dose 20 weeks later)||RA (as well as some forms of cancer)|
|Abatacept (Orencia®)||IV||Every four weeks||RA, JRA, JIA|
|Ustekinumab (Stelara®)||SC||Every 12 weeks||MS|
|Interferon beta-1a (Betaseron®)||SC||Every other day||MS|
|Interferon beta-1b (Avonex® and Rebif®)||Avonex® – IM
Rebif® – SC
|Avonex® – one time per week
Rebif® – three times per week
|Glatiramer acetate (Copaxone®)||SC||Once daily||MS|
|Natalizumab (Tysabri®) 2||IV||Every four weeks*||MS|
|RH - rheumatoid arthritis • JRA - juvenile rheumatoid arthritis • JIA - juvenile idiopathic arthritis • PsA - psoriatic arthritis • AS • ankylosing spondylitis • CD - Chrohn’s disease • UC - ulcerative colitis • MS - multiple sclerosis • 1 IV = intravenous, SC = subcutaneous, IM = intramuscular 2 Caution using more than 24 weeks due to risk of PML.|
Specialist doctors are usually the ones who prescribe these medications. Biologics are often prescribed in combination with other drugs. Your doctor will consider several factors when deciding whether a biologic is right for you.
One factor is the severity of your disease. This includes the number of times you have symptoms, how bad they are, and how often you require painkiller or other medications to control symptoms. Exams could also be considered. If you have Crohn’s disease, a doctor may do a colonoscopy to see damage to the bowel. Test results, and information about your symptoms and concerns, help decide whether a biologic is right for you.
Depending on your symptoms, some specialists may suggest other drugs before trying biologics. If they do not provide enough treatment, the doctor may then add a biologic. Your other treatments may also be replaced with a biologic. Other doctors decide to start a biologic right away, and then stop it once your symptoms improve.
Doctors also consider each drug’s track record. This includes the amount of time the biologic has been available, and the experience that doctors have in using it. For instance, infliximab (Remicade®) has been available for a longer period of time than many other biologics. More information exists on its safety and how well it works. Due to this, infliximab is often used as the first biologic for many people with Crohn’s or rheumatoid arthritis.
The next step is to consider your response to the medication. Once you and your doctor have decided to try a biologic, you need to know whether it makes you feel better. The doctor will follow up with you to check that your treatment is reducing your symptoms. Your body may be healing in ways that you may not notice, so the doctor may also schedule exams to check that the biologic is working. Having regular blood work done allows your doctor to be sure that the medication is not causing other problems. Advise your doctor if you notice bothersome side effects from these drugs. You may need to try more than one biologic to balance all of these factors.
These drugs work best when given by injection. The body would break them down (digest them) if you swallowed them. Intravenous (IV) drugs are given into a vein over a few hours. This means that you must go into a clinic or hospital to have the medication injected. Subcutaneous (SC) medications are given under the skin. This is more convenient, as you can inject yourself at home, without having to go into a clinic for an IV. Finally, intramuscular (IM) biologics are injected deeper beneath the skin, into the muscle.
Biologics often need to be stored in the refrigerator before they are injected. They are sensitive to temperature, and last much longer when stored in a fridge. When you bring a biologic medication home, keep it in the fridge until you are ready to use it. Your pharmacy may provide an ice pack or deliver the drug directly to the clinic where you receive injections.
Most of the time, biologics are safe and have few side effects. The most common side effect is a reaction at the injection site. The spot where you are injected may be red, itchy, or uncomfortable. Taking another drug before your injection may prevent this. An antihistamine for itchy reactions or a painkiller may be used.
Rarely, biologics have more serious side effects. Since they interfere with the immune system, you may be more likely to get an infection. This can range from something minor (like a viral cold) to a serious infection. Infection is more likely in someone who is elderly or has a history of severe infection, or who takes another medication affecting the immune system. For instance, biologics are not recommended for those with a history of tuberculosis (TB) infection. There is a chance that using a biologic may spur the TB to become active again.
Sometimes, the body’s immune system may respond to these drugs. In other words, the immune system may think the drug itself is an invader, and attack to clear the drug before it can take effect. This is more common with the older biologics. It is less likely if biologics are given with other drugs that lower your immune system’s response. If your body does react this way, your doctor may consider trying a different biologic.
One theory suggests these medications may increase your risk for certain types of cancers, especially skin cancer. Although this is very rare, it is important to monitor your skin. Be sure to tell your doctor if you notice any unusual or changing moles or bumps on your skin or changes in your body while taking biologics.
Biologics are new, injectable, and sensitive. This means that they can be very expensive! Luckily, there are usually ways to make sure biologics are affordable for those who need them.
Most provincial drug plans pay for biologics, as long as your doctor applies for coverage. Usually you must have a certain disease, such as Crohn’s. You may have to try other medications first. Some drug companies offer to pay for a portion of the drug if you agree to give them access to your blood work while you are taking it. This helps them identify the effects and develop the drug’s track record. Your private insurance plan may also cover a portion of the cost. Ask your doctor or pharmacist for more details.
Biologics continue to be developed, studied and approved for use as time goes on. For those they suit, this technology can help relieve symptoms and truly improve quality of life. Talk to your doctor or pharmacist if you want more information about biologics.