Biologics have revolutionized the treatment of rheumatoid, psoriatic and other inflammatory types of arthritis for almost two decades, but plenty of misconceptions about them remain. Rheumatologist Eric Matteson, MD, helps separate fact from fiction.
What are biologics made of?
Unlike conventional drugs, which are made of chemicals, biologics are engineered proteins that come from genes. Biological processes stimulate cells from natural sources – such as microorganisms, humans or other animals – to produce these proteins, which are specifically designed to impair or block certain functions of the immune system.
What do biologics do that other medications can’t?
Instead of blocking many different cell actions, as conventional arthritis medications do, biologics target a specific action of proteins that are highly involved in the inflammation behind inflammatory arthritis.
Since biologics are made with “living” components, is there something alive in them? Is that why they are stored in the fridge?
There is not a living component in your medicine. The process that makes the protein involves a live cell, but the end product is purified and packaged and is not live. Think of it like a steak, which also has proteins but they aren’t alive. Much like you can’t leave a steak out or it will go bad, that rule applies to biologics. Room temperature or heat will break down the protein and destroy it.
Why can’t I take a biologic by mouth?
Biologics must be given by shot [infusion or injection] because stomach acids break down the protein. So, much like insulin, which is also a biologic, you have to bypass the stomach because it will destroy the protein.
The side effects sound scary. Which ones do I need to worry about most?
The most common misconception or concern I hear in my practice is that taking biologics will wipe out someone’s immune system, leading to infections, health problems and risk of death. When you take a drug that affects your immune system, you do have to keep an eye out for cancer and infections. So, before you start a biologic, you will be screened for cancer as appropriate for your age and sex, and for infections like tuberculosis and hepatitis. We also recommend everyone on these drugs gets the appropriate immunizations for their age, like flu and pneumonia shots, to reduce infection risk. But people live better and longer with these drugs than without. Major risks are associated far more with the disease and the consequences of untreated disease than these drugs. Biologics reduce the risks of premature death, increased heart disease and the need for joint surgery. Patients with uncontrolled RA are also at higher risk of infection, so controlling the arthritis can also reduce overall infection risk. On balance, you are much better off with treated disease than untreated.
Author: Jennifer Davis
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