Injectable drugs referred to as biologic DMARDs (Disease-Modifying Antirheumatic Drugs)—or simply, biologics—are used to treat rheumatoid arthritis, a chronic condition in which the immune system, which normally fights infection, attacks the lining of the joints, causing swelling, stiffness, and pain. If left untreated, it can lead to irreversible joint damage. About 1.3 million adults in the United States suffer from rheumatoid arthritis. It is most common in women, and in people over the age of 40, though it may occur at any age.
The biologics do not cure rheumatoid arthritis, but they do alleviate symptoms and may help prevent further joint damage. However, they can cause serious side effects and should not be used until after you have tried other therapies.
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If you have been newly diagnosed with rheumatoid arthritis, studies show that other less costly and safer medications work just as well as biologics, so you should try those first. These include nonbiologic DMARDs, such as hydroxychloroquine (Plaquenil and generic), sulfasalazine (Azulfidine and generic), minocycline (Dynacin, Minocin, and generic), and methotrexate (Rheumatrex and generic). In addition, your doctor is also likely to recommend pain relievers, such as
ibuprofen (Advil, Motrin, and generics) and naproxen (Aleve, Naprosyn, and generics), and corticosteroids, such as prednisone. You should also follow an exercise program because studies show such programs improve function in people with rheumatoid arthritis.
If those therapies fail to provide you with enough symptom relief, then it might be time to try a biologic. Between 30 to 70 percent of people who have not benefitted from other rheumatoid arthritis medications experience some measure of relief from biologics. However, people’s responses vary—some people symptoms and function improve, while others may not. Roughly 40 percent of people won't respond to any particular treatment, and will probably need to switch to another biologic.
Nine different biologics are available to treat the symptoms of rheumatoid arthritis, but they are not a cure. They are all very expensive, with some costing more than $5,000 per week. Taking into account the evidence for effectiveness and safety, if you need a biologic drug to treat your rheumatoid arthritis, we have chosen the following asConsumer Reports Best Buy Drugs:
■ Abatacept (Orencia)
■ Adalimumab (Humira)
■ Etanercept (Enbrel)
Studies show that these three medications are as effective as the other biologics for relieving rheumatoid arthritis symptoms, and they also may have lower rates of withdrawal due to adverse effects than some other biologics.
All of the biologics can cause side effects. In studies, people who took a biologic had a higher risk—13 percent versus 12 percent—of experiencing a serious life-threatening allergic reaction, infection, lymphoma, or other serious side effect than those who took a placebo. The serious or potentially life-threatening infections include bacterial infections, such as tuberculosis, pneumonia, or staph, and serious fungal infections. Minor side effects, such as abdominal pain, nausea, and injection site reactions, can also occur, but usually do not require stopping or changing drugs.