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Rheumatoid Arthritis (cont.)

Biologic Response Modifiers

Biologic response modifiers: These agents act like substances produced normally in the body and block other natural substances that are part of the immune response. They block the process that leads to inflammation and damage of the joints. These are targeted treatments that are directed at specific sites in the immune system that are involved in the rheumatoid process.

  • Etanercept (Enbrel): This agent blocks the action of tumor necrosis factor, which in turn decreases inflammatory and immune responses. It is given by subcutaneous injection twice weekly. People taking etanercept must have regular blood tests to measure whether the drug is having any adverse effects on blood cells.
  • Infliximab (Remicade): This antibody blocks the action of tumor necrosis factor. It is often used in combination with methotrexate in people whose rheumatoid arthritis does not respond to methotrexate alone. It is given by intravenous infusion every six to eight weeks. People taking infliximab must have regular blood tests to measure whether the drug is having any adverse effects on blood cells.
  • Adalimumab (Humira): This is another blocker of tumor necrosis factor. It reduces inflammation and slows or stops worsening of joint damage in fairly severe rheumatoid arthritis. It is given by subcutaneous injection every two weeks. People taking adalimumab must have regular blood tests to measure whether the drug is having any adverse effects on blood cells.
  • Certolizumab (Cimzia): This is another blocker of tumor necrosis factor. It reduces inflammation and slows or stops worsening of joint damage in fairly severe rheumatoid arthritis. It is given by subcutaneous injection every four weeks. People taking certolizumab must have regular blood tests to measure whether the drug is having any adverse effects on blood cells.
  • Golimumab (Simponi): This is another blocker of tumor necrosis factor. It reduces inflammation and slows or stops worsening of joint damage in fairly severe rheumatoid arthritis. It is given by subcutaneous injection every four weeks. People taking golimumab must have regular blood tests to measure whether the drug is having any adverse effects on blood cells.
  • Anakinra (Kineret): This agent blocks the action of interleukin-1, which is partly responsible for the inflammation of rheumatoid arthritis. This in turn blocks inflammation and pain in rheumatoid arthritis. This agent is usually reserved for people whose rheumatoid arthritis has not improved with DMARDs. It is given by subcutaneous injection daily. People taking anakinra must have regular blood tests to measure whether the drug is having any adverse effects on blood cells.
  • Abatacept (Orencia): This agent inhibits T-lymphocytes that contribute to the inflammation and pain associated with rheumatoid arthritis. This drug is reserved for individuals who do not respond to DMARDs, methotrexate, or TNF blockers. It is administered by intravenous infusion. Abatacept may increase the risk of serious infections.
  • Rituximab (Rituxan): Given by intravenous infusion over four to five hours, twice, two weeks apart, every four to 10 months, this biologic response modifier decreases the number of B-cells, a type of immune cell that plays an integral role in causing rheumatoid inflammation and damage. Rituximab may increase the risk of serious infections.
  • Tocilizumab (Actemra): The agent blocks the chemical messenger interleukin-6 (IL-6) that plays a role in activating the immune system that is responsible for rheumatoid arthritis. Tocilizumab is given intravenously once a month. Regular blood testing is required to monitor for potential side effects on blood cells, liver, and cholesterol levels.
  • Tofacitinib (Xeljanz) is the first oral biologic DMARD to treat adults with moderately to severely active rheumatoid arthritis in which methotrexate did not work well. This prescription medicine is taken by mouth twice daily. It blocks special enzymes of inflammation called Janus kinase within cells and is also referred to as a JAK inhibitor.

While biologic medications are often combined with traditional DMARDs in the treatment of rheumatoid arthritis, they are generally not used with other biologic medications because of the unacceptable risk for serious infections.

Medically Reviewed by a Doctor on 5/7/2014

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Rheumatoid Arthritis »

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown cause that primarily affects the peripheral joints in a symmetric pattern.

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