Patients living with rheumatoid arthritis have many choices when it comes to medication designed to prevent inflammation and further joint damage.  In this post we will be discussing the biologic drugs, or “biologics.”  Protein-based and derived from living cells cultured in a laboratory, biologics target specific parts of the immune system rather than the entire immune system as do the traditional systemic drugs (ie. methotrexate, sulfasalazine, cyclosporine).  

The biologics (often monoclonal antibodies) act by blocking the action of a specific type of immune cell (T-cell or B-cell lymphocytes) or by blocking proteins in the immune system such as interleukin-1, interleukin-6, or tumor necrosis factor-alpha (TNF-alpha).  These cells and proteins play major roles in the development of inflammatory autoimmune diseases such as rheumatoid arthritis.

As an RA patient who also has multiple sclerosis (MS), I cannot use one of the anti-TNF drugs as they are contraindicated in patients with known demyelinating diseases such as MS.  Because of this I had not thoroughly researched them before, but with the approvals of Cimzia, Simponi and Actemra, it seems to be a good time to learn how the drugs compare.  

Cimzia (certolizumab pegol), Simponi (golimumab), Enbrel (etanercept), Humira (adalimumab), and Remicade (infliximab) are drugs which block the action of TNF-alpha, a pro-inflammatory immune system mediator (cytokine) produced by adipose tissue (fat) in the body and other types of cells.  Kineret (anakinra) blocks the activity of interleukin-1 (IL1), a pro-inflammatory cytokine which stimulates T-cells.  Actemra (tocilizumab) is also an interleukin receptor inhibitor, specifically aimed at interleukin-6 (IL6).  Orencia (abatacept) is an immunomodulator which blocks the activity of T-cells, a type of immune cell in the body that causes swelling and joint damage in people who have arthritis.  Rituxan (rituximab) is a monoclonal antibody therapy which targets the protein CD20 found on pre-B and mature B-cell lymphocytes.

I started using Rituxan in November 2009 while continuing to use methotrexate. You can read about my first infusion experience, the second Rituxan infusion, insurance coverage and an assistance program I participated in.  

Did you know that the first of these medications were FDA-approved over 10 years ago?  Enbrel and Remicade were approved for use in RA in 1998 and 1999, respectively.  Kineret and Humira were approved in 2001 and 2002, while Orencia and Rituxan were approved in 2005 and 2006.  Simponi and Cimzia were approved in 2009.  Actemra was approved in January 2010.

The biologics are taken by subcutaneous injection or by IV infusion.  Cimzia, Simponi, Enbrel, Humira and Kineret are injected under the skin in the legs, abdomen or arms, typically by the individual with arthritis or a family member.  Actemra, Rituxan, Remicade and Orencia are given through IV infusion in a doctor’s office, infusion center, or hospital.