Biologic DMARDs, also known as biologics, represent a modern class of medications used to manage chronic inflammatory and autoimmune conditions. These treatments are distinct from traditional drugs because they are developed from living organisms, such as cells, rather than being chemically synthesized. They are a subset of disease-modifying antirheumatic drugs (DMARDs), which aim to slow or halt disease progression. Biologics offer a targeted approach to conditions where the immune system mistakenly attacks the body’s own tissues.
Understanding How Biologics Work
Biologic DMARDs function by precisely targeting specific components of the immune system that contribute to inflammation and disease progression. Unlike older, conventional DMARDs that broadly suppress the immune system, biologics block particular proteins, cells, or pathways involved in the inflammatory response. For example, some biologics, known as TNF inhibitors, specifically block tumor necrosis factor (TNF), an inflammatory protein. Other biologics may interact with different types of white blood cells, such as T-cells or B-cells, or block inflammatory chemicals called cytokines.
Biologics are considered “disease-modifying” because they alter the underlying disease process, rather than just managing symptoms. By targeting the precise mechanisms driving inflammation, they can slow or even stop the progression of autoimmune conditions, helping to prevent long-term tissue damage.
Conditions Biologics Treat
Biologic DMARDs treat various autoimmune and inflammatory conditions. Rheumatoid arthritis (RA) is a common condition treated with biologics, where they help reduce joint inflammation and prevent further joint destruction. For individuals with psoriatic arthritis (PsA), biologics address both joint inflammation and skin symptoms associated with psoriasis.
Ankylosing spondylitis (AS), a form of arthritis primarily affecting the spine, also responds to biologic therapy, which helps reduce spinal inflammation and stiffness. Beyond arthritic conditions, biologics are used for inflammatory bowel diseases like Crohn’s disease and ulcerative colitis. In these conditions, biologics work to calm the excessive immune response in the digestive tract, alleviating symptoms and promoting healing. Psoriasis, a skin condition characterized by red, scaly patches, is another area where biologics offer relief by targeting the inflammatory pathways in the skin.
Receiving Biologic Treatment and What to Expect
Biologic treatments are administered either through subcutaneous (under the skin) injections or intravenous (into a vein) infusions. Subcutaneous injections can often be self-administered at home using prefilled syringes or auto-injectors, typically ranging in frequency from once a week to once a month, depending on the specific medication. Intravenous infusions are usually given in a doctor’s office or infusion clinic, with frequencies varying from every few weeks to every few months.
Biologic therapy carries an increased risk of infection because these medications modulate the immune system. Patients may experience a higher susceptibility to common infections like upper respiratory infections, urinary tract infections, and skin infections. There is also a risk of opportunistic infections, such as tuberculosis (TB) or hepatitis B. For this reason, pre-screening for latent TB infection and hepatitis B is conducted before starting biologic therapy. If latent TB is detected, treatment for it may be initiated before or concurrently with the biologic.
Injection site reactions, such as redness, pain, itching, or swelling, are common with subcutaneous administration but are usually mild and temporary. Infusion reactions can also occur with intravenous administration, potentially causing symptoms like fever, chills, headache, or flushing. Healthcare professionals often monitor patients for these reactions and may adjust infusion rates or administer pre-medications to help manage them. Regular monitoring, including blood tests, is part of biologic therapy to detect potential side effects like changes in blood counts or liver function. Individual responses to biologic treatments can vary, requiring careful management for the safest and most beneficial outcome.