Before starting a biologic drug for rheumatoid arthritis (RA), you will need to undergo a screening process that evaluates your medical history and current health condition. You will want to discuss dosage, schedules, and methods for taking a biologic drug with your health care provider. You may also need to have some vaccinations to prevent infections while your immune system is suppressed by the biologic medication.
Biologic drugs work by targeting overactive proteins in the immune system that cause inflammation in joints and recurring joint pain and swelling. Biologics can be very effective in reducing disease activity in moderate to severe rheumatoid arthritis, but risk factors should be assessed before beginning biologic treatment.
Biologic therapy is considered appropriate for people with RA when other disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, hydroxychloroquine, leflunomide, and sulfasalazine, have not provided adequate relief from symptoms. Biologics are often used in combination with methotrexate.
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Many myRAteam members have shared questions about starting a biologic drug. “My doctor is planning on starting me on a biologic soon, since my symptoms have not gotten better on methotrexate and plaquenil,” a member wrote. “To those who have tried or are currently on biologics: what was/is your experience?”
“I’m starting to feel a little optimistic,” another member said. “I went to my rheumatologist yesterday. Plans are in motion for biologics. I’m hopeful.”
Tests are prescribed before starting a biologic drug to determine if you have an underlying — or silent — infection. Biologic drugs increase the risk for infection because they suppress agents in the immune system. An existing infection will usually need to be treated prior to beginning biologic treatment. People with RA are typically given these tests for silent infections:
Other blood tests will determine baseline indicators that should be monitored while taking a biologic. Here are some baseline tests:
Doctors prescribe several types of biologic drugs to treat RA, which are taken, dosed, and scheduled in a variety of ways. Biologics used to treat RA include Cimzia (certolizumab pegol), Enbrel (etanercept), Humira (adalimumab), and Remicade (infliximab). Talk to your rheumatologist and health care team about specifications for any biologic drug recommended for you.
Currently available biologic drugs consist of large molecule compounds that cannot be effectively absorbed in the digestive system if taken orally. They must be taken by infusion or injection. Infusions require a clinical setting, as they are given through an IV needle that administers the drug directly into the blood system.
Biologic injections are administered by syringes and auto-injectors that release the drug subcutaneously — under the skin. Some biologic drugs can be safely and conveniently self-injected at home.
Read more about self-injection.
Dosage for biologic drug treatment can change over time. You may be prescribed a loading dose, which is a clinical term for an increased dose of medication that can quickly reach a steady state of concentration in the body. A loading dose of a biologic drug can achieve faster therapeutic results, which is why biologics are often administered in higher doses at the start of treatment. This process is known as dose loading. As treatment continues, dosage may then be tapered down. Loading doses vary between medications.
Biologic drugs are prescribed on a wide range of schedules. Higher doses may be given on a weekly basis at the beginning of treatment and then tapered off to one dose every few weeks. Some biologics are taken only once every eight weeks, after doses are reduced.
“I'm on a biologic, infused every six weeks, and personally, it's been a miracle,” said one myRAteam member. “I'm now in remission and feel so blessed to feel like my old self!”
Talk to your doctor and find out if your biologic treatment allows you any choice in your treatment schedule. Be sure you thoroughly understand your treatment plan. It’s important to carefully adhere to the schedule required for the particular biologic drug you are taking.
When taking a biologic drug, you have an increased risk for infection because the medication is designed to suppress parts of the immune system. Other common side effects for biologics include reactions at the site of injection, headache, and nausea. If you have a sign of a serious infection, report it immediately to your rheumatologist and health care team. Signs of serious infection include any of the following symptoms:
Discuss side effects with your doctors and get medical advice about how best to manage them.
Biologic drugs often take time to start taking effect. Some people with RA feel better after their first treatment, but more commonly, biologic drugs can take a few weeks or months for the initial response. With biologic drugs, it’s essential to maintain treatment and be patient as the medication takes effect.
“I feel like a million bucks after my infusion. I wouldn't trade that for anything. I can do things, it's amazing,” one myRAteam member said. “It really is worth it.”
On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 147,000 members come together to ask questions, give advice, and share their stories with others who understand life with rheumatoid arthritis.
Are you living with rheumatoid arthritis and considering biologic treatment? Share your experience in the comments below, or start a conversation by posting on your Activities page.