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Understanding Rheumatoid Arthritis Medications (cont.)

Biologic Drugs

Drugs in this class include abatacept (Orencia), etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), tocilizumab (Actemra), and anakinra (Kineret).

  • How biologic drugs work: These agents inhibit key factors responsible for inflammatory responses in the immune system. Abatacept inhibits T-cell activation. Etanercept, infliximab, and adalimumab are tumor necrosis factor (TNF) antagonists. Tocilizumab blocks interleukin-6 (IL-6), and anakinra inhibits interleukin-1 (IL-1).

Abatacept (Orencia)

  • Who should not use this medication: People with allergy to abatacept or those with severe infection should not take this medication.
  • Use: Abatacept is given intravenously (IV) as an infusion over 30 minutes. During the first month, it is given every two weeks, then every four weeks thereafter. It may be used alone or with DMARDs. Orencia is also given as a weekly subcutaneous injection.
  • Drug or food interactions: Abatacept should not be administered if TNF antagonists, such as etanercept, infliximab, or adalimumab, are also being given to treat rheumatoid arthritis. Combining these therapies greatly increases the risk for serious infection. Additionally, it should not be given with anakinra since this combination has not been studied adequately.
  • Side effects: If serious infection occurs, abatacept should be discontinued. Abatacept must be used with caution in individuals with chronic obstructive lung disease (COPD) since these individuals are more likely to develop side effects that exacerbate their COPD. Common side effects include the following:
    • Headache
    • Upper respiratory tract infection
    • Sore throat
    • Nausea

Etanercept (Enbrel)

  • Who should not use this medication: People with allergy to etanercept and those with serious infection or active tuberculosis should not take the drug.
  • Use: Etanercept is taken as an injection once or twice a week. It may be used alone or with concomitant therapy such as methotrexate.
  • Drug or food interactions: Etanercept may increase infection risk or decrease blood cell counts when used with other immune modulators or immunosuppressant drugs (for example, anticancer agents or corticosteroids). Immunization with some vaccines may not be effective.
  • Side effects: Etanercept must be used with caution in people with heart failure or impaired kidney function. If a serious infection develops, the drug must be discontinued. Exacerbation of tuberculosis and the development of drug-induced lupus are other possible side effects. The following adverse effects are possible:
    • Injection site pain, redness, and swelling
    • Fever
    • Rash
    • Cold or flu symptoms
    • Stomach upset
    • Nausea
    • Vomiting

Infliximab (Remicade)

  • Who should not use this medication: People who have moderate to severe heart failure should not take doses greater than 5 mg/kg (of body weight). Those with allergy to infliximab or mouse protein should not take the drug. Patients with active infection, including tuberculosis, should not use the drug.
  • Use: Infliximab is given as a two-hour intravenous infusion in a doctor's office. Initially, three doses are given within a six-week period; thereafter, a single dose is given every eight weeks to maintain the drug's effect. The interval between doses is shortened if the eight-week regimen fails to control symptoms. It is most often used with concomitant methotrexate.
  • Drug or food interactions: Use of other immunosuppressant drugs increases the risk for infection.
  • Side effects: Infliximab may increase the risk of infection, particularly when other immunosuppressant drugs are used concurrently. People with heart failure may experience worsening of heart disease. Infliximab may exacerbate tuberculosis and drug-induced lupus. Symptoms could include fever, rash, headache, or muscle aches three to 12 days after infusion. The body may eventually produce antibodies toward infliximab, thereby decreasing the drug's effectiveness.

Adalimumab (Humira)

  • Who should not use this medication: People with allergy to adalimumab must not use it. Treatment must not be started if an active infection is present.
  • Use: Adalimumab is given as an injection every other week (or sometimes weekly). It is most often used with concomitant methotrexate.
  • Drug or food interactions: Clinical investigators are studying whether other immunosuppressant drugs increase the risk for infection if administered with adalimumab.
  • Side effects: Adalimumab must be used with caution in people with a history of mouse protein allergy, nervous system disorders, or heart disease. Adalimumab may increase blood pressure or cause heart rhythm abnormalities. Adalimumab may cause exacerbation of tuberculosis and drug-induced lupus. Call a doctor if symptoms of lung or sinus infection (for example, fever, cough, sinus pressure or headache) develop.

Tocilizumab (Actemra)

  • Who should not use this medication: Do not take tocilizumab if you are allergic to it or any of its ingredients.
  • Use: Tocilizumab is given as a monthly intravenous infusion or subcutaneous weekly injection.
  • Drug or food interactions: The risk of serious infections (for example, pneumonia) may increase if tocilizumab is taken with other biologic medications.
  • Side effects: Call a doctor if any of the following occur:
    • Itching
    • Rash
    • Fever
    • Chills
    • Sore throat
    • Joint pain or swelling
    • Sores or white patches in the mouth or throat

Anakinra (Kineret)

  • Who should not use this medication: People with allergy to anakinra or Escherichia coli-derived proteins should not take anakinra. Treatment must not be started if an active infection is present.
  • Use: Anakinra is taken as a daily injection at approximately the same time each day.
  • Drug or food interactions: The risk of serious infections (for example, pneumonia) may increase if anakinra is taken with tumor necrosis factor antagonists such as etanercept (Enbrel), adalimumab (Humira), or infliximab (Remicade). Anakinra does not cause drug-induced lupus.
  • Side effects: Common adverse effects include nausea, diarrhea, or abdominal pain. Call a doctor if any of the following occur:
    • Itching
    • Rash
    • Fever
    • Chills
    • Sore throat
    • Joint pain or swelling
    • Sores or white patches in the mouth or throat

Tofacitinib (Xeljanz)

First in a new class of drugs for rheumatoid arthritis, tofacitinib is a janus kinase inhibitor (JAK inhibitor) that works by blocking chemical messengers responsible for inflammation in rheumatoid arthritis. It is given orally twice daily. Side effects include cancer, interference with normal immune response resulting in infections, perforation of the stomach, and blood test abnormalities. It is not known if tofacitinib is harmful during pregnancy, and it is not recommended during pregnancy or breastfeeding.

Medically Reviewed by a Doctor on 8/13/2014

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