Rheumatoid Arthritis Support Group
Rheumatoid arthritis is a chronic, inflammatory, multisystem, autoimmune disorder. It is a disabling and painful condition which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and...
MPORTANT MEDICATION INFORMATION. Coming soon to the Arthritis Foundation Website:
Reference Biologics and Biosimilars
There are two main groups of biologics: reference biologics and biosimilars. Reference biologics are the original biologics introduced to the market. Biosimilars are more newly available, and an increasing number will enter the market in 2023.
Different types of biologic drugs have different “mechanisms of action,” meaning that they target different inflammatory chemicals and work differently in the body to control inflammation. In some cases, people take methotrexate or another type of traditional DMARD along with the biologic.
There are four classes of biologics – TNF Inhibitors, IL Inhibitors, selective costimulation modulators and B-cell inhibitors. In each section below, links to our online drug guide are included. Each biologic has benefits and risks. Please note that we are continuously updating information so always check back for the latest updates.
TNF Inhibitors
Most commonly used biologics for RA, they block tumor necrosis factor (TNF), a cytokine (a kind of protein) that plays a role in fueling inflammation. They include adalimumab (brand name Humira), certolizumab pegol (Cimzia), etanercept (Enbrel), golimumab (Simponi and Simponi Aria) and infliximab(Remicade, Avsola, Inflectra and Renflexis).
Typically, if a TNF blocker isn’t effective enough to control rheumatoid arthritis or if the person doesn’t tolerate it well, the doctor might prescribe a different TNF inhibitor. More likely, though, the doctor may recommend a biologic with a different mechanism of action, or possibly a JAK inhibitor (more information below).
IL Inhibitors
They target interleukins (IL), a group of cytokines that help to regulate how the immune system works. Different IL inhibitors target different interleukins. The biologics used to treat RA include anakinra (brand name Kineret), which blocks interleukin-1 (IL-1); as well as sarilumab (Kevzara) and tocilizumab (Actemra), which both block interleukin-6 (IL-6).
Selective costimulation modulators
They prevent the activation of T cells that help to fuel inflammation. The only drug for RA that uses this mechanism of action is abatacept (brand name Orencia).
B-Cell Inhibitors
The biologic rituximab (brand names Rituxin, Ruxience and Truxima) blocks B cells and helps to lower inflammation.. It isn’t generally prescribed to people who have severe heart or breathing problems and those who have had tuberculosis or hepatitis.
JAK Inhibitors
JAK inhibitors work by blocking one or more enzymes (known as Janus kinases) that play a role in inflammation. They are not biologics. Biologics are large-molecule therapies given by injection (autoinjectors) or infusion. JAK inhibitors are small-cell therapies that are available in pill form.
JAK inhibitors may be used for people who haven’t had adequate response to or can’t tolerate one or more biologics.
There are three JAK inhibitors used to treat RA: baricitinib (Olumiant), tofacitinib (Xeljanz) and upadacitinib(Rinvoq). A boxed warning was added to JAK inhibitors in 2021 after a study showed that one of them — Xeljanz— was more likely than a TNF inhibitor biologic to result in heart attack, stroke, cancer, blood clots and death in certain patients. The study did not include the other JAK inhibitors, but because they work in similar ways, the FDA extended the warning to all three JAK inhibitors. The patients who were at higher risk were smokers, men, those over 65 years old, and those who have previously had a heart attack, stroke or cancer other than nonmelanoma skin cancer that was successfully treated.
All drugs carry risks, and it’s up to you and your doctor to determine how severe your RA is and to consider your overall health, other conditions and medications you might be taking.
MarleneJ
Good review, WG!
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