Doctor Discussion Guide: Questions to Ask About Biologics for RA

Biologics are products derived from living systems, such as human cells. Biologic drugs can be used to target specific parts of your immune system that play a role in inflammation. This can help relieve symptoms of RA and prevent joint damage.

In most cases, your doctor will prescribe a biologic drug only if more traditional treatments have proven ineffective. But for some, your doctor might prescribe a biologic drug first.

Your doctor might prescribe a biologic drug that interferes with one of the following parts of your immune system:

• Tumor
  necrosis factor (TNF). This is a protein that drives joint inflammation.
  TNF-inhibitors include:
  • adalimumab (Humira)
  • certolizumab pegol (Cimzia)
  • etanercept (Enbrel)
  • golimumab (Simponi)
  • infliximab (Remicade)
  • Interleukins
    (ILs). These are a class of proteins that play a role in your immune
    system. Different types of biologic drugs target IL-1, IL-6, IL-12, or IL-23.
    IL-inhibitors include:
    • anakinra (Kineret)
    • canakinumab (Ilaris)
    • rilonacept (Arcalyst)
    • tocilizumab (Actemra)
    • ustekinumab (Stelara)
    • B-cells.
      These are a type of antibody that are involved in inflammation.
      B-cell-inhibitors include:
      • belimumab (Benlysta)
      • rituximab (Rituxan)
      • T-cells.
        These are a type of white blood cell involved in immune system reactions that
        cause inflammation. Abatacept (Orencia) is a T-cell-inhibitor. It’s also known
        as a selective co-stimulation modulator.

Currently, there’s no way to know in advance if a biologic drug will work for you. If you try one type of biologic drug that doesn’t work, your doctor might prescribe another.

Ask your doctor how long it usually takes for the effects of a prescribed biologic drug to set in. If you don’t experience the anticipated effects, let your doctor know.

Different types of biologic drugs are administered through different routes. Some are given in pill form. Many others are given intravenously. In some cases, you might receive intravenous infusions from a healthcare professional. In others, your doctor might teach you how to self-inject your prescribed medication.

If your doctor discusses prescribing a biologic, consider asking questions such as:

• Is the drug administered as an infusion,
  self-injection, or pill?
• How many doses of the drug will I receive?
• What is the recommended dosage schedule?
• Will I be able to give myself the drug, or will
  a healthcare provider administer it?

For many people, the potential benefits of taking a biologic drug outweigh the risks. But like any medication, biologic drugs can cause adverse side effects.

All biologic drugs for RA suppress your immune system. This raises your risk of contracting infections, such as the common cold, sinus infections, urinary tract infections, and skin infections.

Some types of biologic drugs may also:

• interact with other drugs, supplements, or
  herbal products that you take
• trigger an injection-site or infusion-related
  reaction, which might result in redness, swelling, itching, rash, nausea,
  vomiting, trouble breathing, or other symptoms
• increase your risk of developing certain types
  of cancer, congestive heart failure, multiple sclerosis, shingles, or liver
  damage
• make symptoms of chronic obstructive pulmonary
  disease (COPD) worse
• raise your cholesterol, triglyceride, or liver
  enzyme levels
• cause false results in blood glucose readings
• cause other adverse side effects

The risks vary, depending on the specific biologic drug that you take and your personal medical history. Before you start taking a drug, ask your doctor about the associated risks and tell them about any:

• potential signs or symptoms of infection that
  you have
• health conditions that you’ve been diagnosed
  with, such as tuberculosis, diabetes, or COPD
• medications and supplements, and herbal products
  that you take, including recent vaccinations
• surgeries that you’ve recently undergone or
  scheduled

You should also tell your doctor if you’re nursing, pregnant, or trying to get pregnant. Many biologic drugs aren’t recommended for people who are pregnant or nursing. If you become pregnant while taking a biologic drug, tell your doctor immediately.

If you take a biologic drug, it’s important to learn how to recognize and respond to potential adverse side effects. Your doctor might also recommend strategies for limiting your risk of side effects. For example, they might order medical tests to check for signs of infection, liver damage, or other issues.

Before you start taking a biologic drug, ask your doctor:

• Should I undergo any medical tests before,
  during, or after treatment with this drug?
• What signs and symptoms of adverse side effects
  I should watch out for?
• What should I do if I develop signs or symptoms
  of adverse side effects?
• Are there any medications, supplements, or vaccines
  that I should avoid while taking this drug?
• Are there any other steps that I can take to
  lower my risk of side effects?

You should talk to your doctor before getting any vaccines while taking a biologic drug. While most vaccines are safe to get while you’re taking biologics, some live virus vaccines may not be. Your doctor might advise you to get your vaccinations updated before you start taking biologics.

If you experience any signs or symptoms of adverse side effects, let your doctor know right away.

Combining multiple types of biologic drugs can increase your risk of adverse side effects. However, your doctor might prescribe one type of biologic drug alongside other non-biologic treatments.

In addition to a biologic drug, your recommended treatment plan might include one or more of the following:

• non-biologic disease modifying antirheumatic
  drugs (DMARDs), such as methotrexate
• nonsteroidal anti-inflammatory drugs (NSAIDs),
  such as ibuprofen
• corticosteroids, such as prednisone
• physical or occupational therapy
• use of braces or assistive devices
• massage or other complementary therapies
• changes to your exercise, eating, sleep, or
  stress management habits

Ask your doctor if you should make any changes to your current treatment plan before you start taking a biologic drug.

A biologic drug can potentially help you manage symptoms of RA and lower your risk of joint damage. But like any medication, biologic drugs come with potential side effects. Before you start taking a drug, learn about the potential benefits and risks of adding it to your treatment plan. Tell your doctor about your personal medical history and ask how a biologic drug might impact you.