Video Q & A:

Biologics

Question:

Do all biologics work in the same way?

Expert:   Linda Russell, MD, Hospital for Special Surgery »

All biologics target your immune system, but they affect different cells and molecules within it. Find out which medication treats what.

Transcript: Biologic response modifiers treat rheumatoid arthritis in various ways. While they are all created from human proteins, biologics target DISTINCT components of your overactive immune system. Tumor necrosis factor INHIBITORS – or TNF inhibitors -- were the FIRST biologics available to treat rheumatoid arthritis. TNF is chemical messenger that causes inflammation. It is derived from cells called macrophages – they are the garbage men of the immune system that sweep through the bloodstream picking off invading bacteria and viruses. But in an autoimmune disease like rheumatoid arthritis the whole “attack” system goes awry. There too much TNF – or it’s causing inflammation in tissue that should remain healthy. These INHIBITORS tamp down the renegade TNF and ease inflammation and pain. Nine biologics have been approved. Five of them are tumor necrosis factor--or TNF- inhibitors—etanercept, infliximab, adalimumab, certolizumab pegol, and golimumab. They keep TNF from promoting the inflammation that CAUSES pain and joint damage associated with RA. ANOTHER biologic that treats RA is called ABATACEPT It’s an alternative to TNF-inhibitors, and is used to prevent misguided immune system T-cells from going to the joints, where they cause inflammation. B-cells are immune system cells that are supposed to FIGHT infection by helping produce antibodies to ward off disease; but in people with RA these B-cells aren’t functioning correctly. RITUXIMAB, another singular biologic, DEPLETES the body’s B-cells which eases inflammation and reduces the autoimmune reaction in the body. TOCILIZUMAB is the only biologic that slows the progress of RA by BLOCKING interleukin-6 activity. Interleukin-6 is an inflammatory protein molecule produced by both B AND T cells. And Interleukin-1, ANOTHER inflammatory molecule, is blocked by the biologic ANAKINRA. Since ALL biologics impact your immune system, they put you at an increased risk for infections. Patients should not take biologics if they have tuberculosis, hepatitis B, or any active bacterial infection. And, not all biologics are right for YOU. Your doctor will determine YOUR individual RA treatment based on your medical history. The decision to use a particular drug should be based on a thorough discussion with your doctor about the risks and benefits. More »

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