While biologic treatments do not cure rheumatoid arthritis (RA), they can slow its progression. They may also cause fewer side effects than other kinds of medications.

Biological response modifiers are a class of drugs used to treat rheumatoid arthritis (RA). Your doctor may suggest that you start right after your diagnosis, which can help address joint damage.

Your doctor may give you a biologic alongside or in place of methotrexate, an anti-rheumatic. Taking a biologic with methotrexate is effective in treating RA for many people.

Keep reading to learn more about the different biologics available, potential side effects, and other options.

Biologic DMARDs (bDMARDs) work by targeting immune system pathways.

They often inhibit various proteins, receptors, and cells that cause inflammation such as interleukin-6 (IL-6), interleukin-1 (IL-1), c-reactive protein (CRP), and CD80/86.

bDMARDs in this class of drugs the Food and Drug Administration (FDA) approved for rheumatoid arthritis include:

  • tocilizumab (Actemra)
  • sarilumab (Kevzara)
  • anakinra (Kineret)
  • abatacept (Orencia)
  • rituximab (Rituxan)

Tumor necrosis factor alpha, or TNF alpha, naturally occurs in the body. It can increase in people with RA, causing pain and swelling.

TNF-alpha inhibitors help to inhibit this increase in TNF. Biologic DMARDs also include TNF-alpha inhibitors such as:

Biosimilars are categorized as TNF-alpha inhibitors or bDMARDs and are similar enough to current biologics to produce similar results.

Biosimilars used to treat RA include:

  • adalimumab-afzb (Abrilada)
  • adalimumab-atto (Amjevita)
  • infliximab-axxq (Avsola)
  • adalimumab-adbm (Cyltezo)
  • etanercept-szzs (Erelzi)
  • etanercept-ykro (Eticovo)
  • adalimumab-bwwd (Hadlima)
  • adalimumab-fkjp (Hulio)
  • adalimumab-adaz (Hyrimoz)
  • infliximab-dyyb (Inflectra)
  • infliximab-abda (Renflexis)

Some of these drugs work fairly quickly. Others may take weeks or months to take full effect. Each person responds to these drugs differently, and not everyone responds well to the same drug.

Some people may be able to take a biologic alone. However, you may need a biologic plus another class of drug, such as methotrexate. Biologics taken in combination with another form of treatment has been shown to be effective.

Most biologics are given by injection. Some are injected under the skin. Others must be injected directly into a vein.

Biologics work by interrupting immune system signals involved in the inflammatory process that result in damage to joint tissue.

The first type of biologic approved for use in treating RA was designed to target the protein called TNF. These drugs are called anti-TNF biologics, and they block specific steps in the inflammatory process.

While they don’t suppress the immune system broadly like conventional DMARDs, they do affect immune system function.

Methods

Biologics may work better for some people at controlling RA progression than other DMARDs because they target specific mediators of RA inflammation. These newer biologic drugs work in different ways in the body.

Some of these drugs disrupt certain chemical signals that participate in the inflammation, or they can work directly on T-cells or B-cells to interfere with the inflammatory process.

Many biologics work by interfering with the activity of tumor necrosis factor (TNF), a key immune system protein.

Biologics can have fewer side effects than other types of drugs, but any drug that suppresses the immune system carries risks.

A common side effect may include increased risk of infections. More serious side effects can include multiple sclerosis and lymphoma.

However, a 2017 study found that long-term biologic use does not increase the risk of infection in individuals with RA.

In people living with autoimmune arthritis, the severity of the inflammation has been associated with increased risk for lymphoma.

However, a more recent study has suggested that these medications may not increase cancer risk, so more research is needed.

For many living with other risks, the benefits of managing RA outweigh the risks.

It is important to tell your doctor about any unusual symptoms you have, which can include a fever or other symptoms that you can’t explain.

People with liver disease may not be able to take a biologic drug. If you have liver issues, ask your doctor if biologics are safe for you.

Other non-biologic solutions

Janus-associated kinase (JAK) inhibitors are another treatment option you can consider. They are taken as a pill.

Some JAK inhibitors include:

Biologics are a class of drugs that can treat RA. They can slow the progression of RA by preventing joint damage and bone erosion and may produce fewer side effects in comparison to other treatment options.

If you are interested in trying a biologic for RA, talk to your doctor. They will be able to advise you on the appropriate treatment with your individual needs in mind.

If you are taking biologics, it is also important to talk to your doctor if you experience any side effects.