Biologics & Biosimilars for Axial Spondyloarthritis Treatment
Axial spondyloarthritis (AxSpA) is a chronic, progressive condition. There is no cure, but treatments are available to help you manage the condition. Because there is no cure, the goals of treatment are to maximize quality of life, prevent or slow progressive structural damage, and control symptoms and inflammation and preserve mobility.1
One of the treatments used for AxSpA spectrum conditions is medication. There are different kinds of medication, and what works for one person may not be effective for another. One class of medications that can be used in the treatment of AxSpA spectrum conditions is called disease-modifying antirheumatic drugs, or DMARDs. DMARDs are often used for inflammatory or immune diseases. There are two main kinds of DMARDs: traditional (also called synthetic) and biologics.2
How do biologics work?
Biologic DMARDs are typically prescribed once a physician has evidence that there is disease progression and structural joint damage, despite other therapies.2 The design of these drugs is meant to be very specific and targeted to affect immune function.2
Biologics work by interfering with cytokine production or function. Cytokines are proteins made by certain cells in the immune system that help to regulate immunity and inflammation.
Biologics also work by:
- Inhibiting a second signal needed for T-cell activation that is involved in the inflammation process
- Decreasing B-cells or inhibiting activators of B-cells (which are involved in inflammation)
One biologic, Xeljanz® (tofacitinib), inhibits an enzyme crucial to inflammation and joint damage. Although biologics have been effective in some people, there is no proof that these drugs can actually modify the disease or slow it down.
Biologics may be given orally, by injection, or intravenously (through an IV).
Formulations of biologics
There are various formulations of biologics in different classes. Classes of biologics include TNF (tumor necrosis factor) inhibitors, anti-CD 20 agents, IL-6 (interleukin-6) receptor antagonists, IL-1 receptor antagonists, and Janus kinase enzyme inhibitors.4
Formulations of biologic DMARDs include:4
What are the possible side effects of biologics?
Any drug, whether it’s over-the-counter or prescription, has the potential to cause side effects. Not everyone taking a drug will experience side effects, and those who do have side effects may not have the same side effects. Sometimes side effects go away after a period of time, and sometimes they’re more serious.
Common side effects with DMARDs include rash, nausea or vomiting, and infections.2 Sometimes these infections can be serious, so it’s important to see your doctor if you think you might have an infection while you’re on DMARDs. Biologic DMARDs have a higher risk of viral, bacterial, and/or fungal infections that can be fatal.2 There may also be increased risk for reactivation or primary infection with tuberculosis, herpes zoster or hepatitis.2 Your doctor will do tests to check for hepatitis and tuberculosis prior to starting a biologic. Other serious conditions that may have an increased risk of occurrence while on biologic DMARDs include allergic reactions, congestive heart failure, demyelinating central nervous system disease, hypertension, and kidney problems.2
Before going on biologic DMARDs, talk with your doctor about all of the possible side effects for the specific drug you are considering. They’ll be able to provide you with a better assessment of your risk, given your overall health and personal medical and family history.
Things to know about DMARDs
DMARDs, including biologic DMARDs, may not be appropriate for everyone. People who have an active infection, chronic liver disease, immunodeficiency syndromes, leukopenia, or bone marrow hypoplasia should not take these medications.2 Talk with your doctor if you are pregnant, plan to become pregnant, or if you are breastfeeding. Live vaccines are not recommended while taking a biologic. Your doctor may ask you to notify them of any infections or surgeries and you might be advised to stop the biologic.
Monitoring of DMARD effectiveness and side effects is necessary when taking these medications.
There are other medications besides biologic DMARDs that can be used to help treat AxSpA spectrum conditions. If you find that biologic DMARDs are not right for you, other treatments are available, including non-drug treatments like physical therapy and various lifestyle changes. Talk with your doctor about the range of treatments available for your symptoms to fully address the symptoms you are experiencing.