Biological Response Modifiers

General Indications

Biological response modifiers � commonly referred to as biologics � are generally indicated for people with aggressive, debilitating arthritis, who have not responded to one or more disease modifying agents (DMARDS). Biologics have proven effective for treating the painful inflammation of rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. About 70 percent of patients treated with these medications will see some degree of improvement, but continuing use is required to maintain any benefit.

Biologics are specially designed to target very specific components of the body�s immune system. Some biologics work by neutralizing or �soaking up� a substance called TNF. Other biologics work to turn off cells that play a role in the immune attack. By �soaking up� TNF or by turning off immune cells, these medications help to reduce the symptoms of inflammatory arthritis and reduce the pain and swelling (inflammation) that can cause joint damage.

One advantage of biologics is that they can work quite quickly to reduce inflammation. Some patients may notice an improvement within a few weeks of starting treatment with a biologic. By comparison, the fastest acting DMARD (disease-modifying anti-rheumatic drug) can take 6 to 8 weeks to deliver the same result, while others can take up to six months. Some biologics appear to be most effective when used in combination with DMARDs, particularly methotrexate.

There are currently nine biologics approved for use in Canada. Biologics offer hope for patients with RA who do not respond to current DMARDs.

Commonly Prescribed Biologics
Brand Name	Product	Initial Starting Dose	Benefits Begin
Cimzia	certolizumab pegol	Two subcutaneous injection given at week 0, 2, and 4. This is followed by a maintenance injection once every two weeks.	Benefits begin within weeks, but may take months for the full effect.
Enbrel	etanercept	One subcutaneous injection weekly. (can be self injected or given to you by another individual)	Benefits begin within weeks, but may take months for the full effect.
Humira	adalimumab	One subcutaneous injection every two weeks. Can be self injected or given by someone else	Benefits begin within weeks, but may take months for the full effect.
Kineret	anakinra	One subcutaneous injection daily (can be self injected or given to you by another individual)	Benefits begin within weeks, but may take months for the full effect.
Orencia	abatacept	Intravenous infusion every two weeks to start (first three infusions) and every four weeks thereafter.	Benefits begin within weeks, but may take months for the full effect.
Remicade	infliximab	Intravenous infusion every two months (after 3 initial injections)	Benefits begin within weeks, but may take months for the full effect.
Rituxan	rituximab	Two intravenous infusions two weeks apart. Further infusions, if necessary, 24 weeks later.	Benefits begin within weeks, but may take months for the full effect.
Simponi	golimumab	One subcutaneous injection monthly. Can be self injected or given to you by someone else.	Benefits begin within weeks, but may take months for the full effect.

General Side Effects

Side effects related to biologics are explained in the sections dedicated to each commonly prescribed biologic.

This page was last reviewed/updated on : 06/14/2010

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Biological Response Modifiers