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Infusion Therapy for Rheumatoid Arthritis: Your Guide

Posted on April 26, 2021
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Emily Wagner, M.S.

Infusion therapy is a type of treatment that involves administering medication through a needle. For the treatment of rheumatoid arthritis (RA), infusion therapy involves a class of drugs known as biologics that may be administered intravenously (IV, or into a vein).

RA is an autoimmune disease in which the body attacks its own cells, leading to inflammation in the joints and other parts of the body. Biologics are a subset of disease-modifying antirheumatic drugs (DMARDs) used in RA to help stop the progression of the disease and slow joint damage. These drugs are meant to inhibit different cells of the immune system to decrease inflammation at its source. In the case of RA, biologic DMARDs target immune cells that are causing damage to the lining of the joints.

Why Are Treatments Infused?

Biologics must be infused or injected because they are large, complex proteins. If they were taken by mouth, they would be broken down by stomach acid before they could be effective. Infusions are also beneficial because the drug is able to flow through the body easily, reaching all areas of inflammation that may be affected by RA, which can include multiple organs and areas of the body.

Infusions also offer an alternative to intramuscular (IM) injections — which are administered directly into a muscle — and to subcutaneous (SQ) injections, which are introduced into the fatty layer just below the skin. Typically, these injections are self-administered at home using a special device that contains the drug.

If someone is uncomfortable giving themselves an injection, infusions may be a better option. Additionally, infusions may be required less frequently than injections. Whereas injections are usually given weekly, biweekly, or sometimes monthly, infusions can be done once every few months — depending on the course of treatment and type of drug.

What To Expect From Infusion Treatment

Each biologic infusion treatment used in RA has its own dosing regimen, frequency, and time to improvement. Most therapies have an initial treatment course that requires more frequent dosing in order to ramp up the effects of the drug. Once you finish the initial course, your doctor may require you to undergo maintenance doses every eight weeks or so.

Infusions are typically performed in a doctor’s office or an infusion clinic, and they can last anywhere from 30 minutes to a few hours. Before getting an infusion, remember to stay hydrated by drinking plenty of water to avoid any unwanted side effects. You may also want to bring something to do during the infusion to pass the time. Comfortable clothing is also recommended to make the process as easy as possible.

Which Treatments Are Infused for RA?

There are four main biologic DMARDs that are given by infusion for treating RA:

Each of these drugs works by targeting a different area of the immune system, but they all share the common goal of reducing inflammation and preventing joint damage while slowing disease progression.

Orencia (abatacept)

Orencia is a biologic that blocks an interaction between immune cells known as costimulation. Blocking costimulation prevents the cells from becoming activated and stops inflammation at its source.

Orencia is given by IV infusion or as an SQ injection. The initial doses are given at baseline, two weeks, and four weeks. After the initial course is complete, doses are typically given weekly for SQ administrations or once per month if taken via an IV. The infusions last between 30 and 60 minutes and are performed by health care providers in outpatient infusion centers. You may see improvements within three months, and they can continue throughout the first year of treatment.

Rituxan (rituximab)

Rituxan belongs to a class of biologics that target specialized immune cells known as B cells. B cells are responsible for making antibodies that normally help fight infections in the body. However, in RA, B cells make autoantibodies that attack healthy cells and tissues, causing damage. Rituxan works by eliminating B cells so they cannot make autoantibodies. It is also useful for treating lymphoma.

The first course of Rituxan is typically given through two infusions, two weeks apart. Corticosteroids are also given through an IV approximately 30 minutes before each Rituxan infusion to help prevent unwanted side effects. Rituxan infusions take between three and four hours.

The first course of treatment usually eliminates most of the B cells in the body and decreases levels of rheumatoid factor, an autoantibody found in most people with RA. Overall, you likely won’t notice improvements until three months or more after treatment. Once treatment begins working, the improvements can last six to 12 months or longer. Your rheumatologist may suggest repeating treatments every six months.

Remicade (infliximab)

Remicade is one of many biologics that target the inflammatory protein known as tumor necrosis factor alpha (TNFA). TNFA is responsible for inflammation and bone erosion in RA, and it can be found in high levels in the joints of people with RA. Remicade works by binding directly onto TNFA, preventing it from interacting with immune cells that cause inflammation. Remicade is also used for treating psoriatic arthritis and ankylosing spondylitis (arthritis of the spine).

Remicade is given by IV infusion with doses initially given every 15 days. Once this initial course is complete, infusions may be given every eight weeks for maintenance. Infusions typically last between two and four hours. Oftentimes, Remicade treatment is combined with another DMARD, methotrexate.

Actemra (tocilizumab)

Actemra is a biologic that prevents inflammatory proteins, known as cytokines, from binding to immune cells. This stops the immune cells from becoming activated, decreasing levels of inflammation.

Actemra can be used alone as a monotherapy or in combination with other DMARDs. The infusion itself takes around an hour to complete. It typically takes between four to eight weeks to notice the drug’s effects, a shorter time compared to other infused biologics. The dosing can be increased if a lower initial dose isn’t effective. It can also be given as an SQ injection.

Side Effects of Infusion Therapy

As with any medication, there are potential side effects to infusion therapy with biologic DMARDs. These drugs work by inhibiting the immune system, an effect that can increase the risk of infections. The most common infections include:

  • Upper respiratory infections
  • Skin infections
  • Urinary tract infections

More serious infections can occur, especially in people who already have underlying conditions.

This administration of biologics can also lead to infusion reactions (similar to an allergic reaction), which are most common after the first infusion. Most cases are mild and can be treated with antihistamines. Symptoms of an infusion reaction include:

  • Itching
  • Swelling
  • Hives
  • Difficulty breathing
  • Chills or fever
  • Changes in blood pressure

In some cases, treatment with Rituxan can lead to reactivation of viral infections that are dormant in the body, such as hepatitis B infection. This can be prevented by screening for hepatitis B before beginning treatment.

Connect With Others Who Understand

If you or a loved one is living with rheumatoid arthritis, consider joining myRAteam, the social network for people with RA. More than 148,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA.

Have you had infusion therapy to treat your RA? Share your experience in the comments below, or start a discussion on myRAteam.

References

  1. About Infusion Therapy — National Home Infusion Association
  2. Rheumatoid Arthritis — Mayo Clinic
  3. Biologics — Arthritis Foundation
  4. Rheumatoid Arthritis Treatment — Johns Hopkins Arthritis Center
  5. Rituximab (Rituxan and MabThera) — American College of Rheumatology
  6. Remicade: Is This the Best Medication for Rheumatoid Arthritis? — RheumatoidArthritis.org
  7. Rituximab for Lymphoma — Lymphoma Action
  8. Rheumatoid Factor — Mayo Clinic
  9. Remicade — National Psoriasis Foundation
  10. Infliximab in the Treatment of Ankylosing Spondylitis — Biologics: Targets and Therapy
  11. Infliximab (Remicade) — American College of Rheumatology
  12. Defining the Difference: What Makes Biologics Unique — Biotechnology Healthcare
  13. Hepatitis B Virus Reactivation With a Rituximab-Containing Regimen — World Journal of Hepatology
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

A myRAteam Member said:

I've just had round one in January and so far it's working great. I have my next appt in July and my Rheumy said it may fade prior to my next infusion. We'll see.

posted about 1 month ago

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