Biologics & Biosimilars for Axial Spondyloarthritis Treatment

Reviewed by: HU Medical Review Board | Last reviewed: May 2022 | Last updated: June 2022

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:1

  • Maximize quality of life
  • Prevent or slow progressive structural damage
  • Control symptoms and inflammation
  • Preserve mobility

Biologics are a class of drugs used to treat AxSpa spectrum disorders in some people. Biologics are a special type of disease-modifying anti-rheumatic drugs (DMARDs). DMARDs are often used to treat inflammatory or immune diseases. There are 2 main kinds of DMARDs: traditional (also called synthetic) and biologics.2

Biologics are drugs made from living cells. These cells can come from parts of the blood, proteins, bacteria, or tissue. This process turns the cells into drugs that can prevent, treat, and cure disease. Drugs similar in structure to known biologic drugs are called biosimilars.

Biologic DMARDs are usually prescribed for AxSpa once a doctor has evidence that there is disease progression and structural joint damage despite other treatments.2

How do biologics work?

Biologics and biosimilars are designed to target specific parts of the immune system that affect inflammation. They 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.2,3

Biologics also work by:2,3

  • Blocking a signal needed for T-cell activation that is involved in the inflammation process
  • Decreasing B-cells or blocking activators of B-cells that are involved in inflammation

While biologics are effective in some people, there is no proof that these drugs can actually modify the disease or slow it down.

Examples of biologics for AxSpa

There are different types of biologics, including:4

  • Tumor necrosis factor (TNF) inhibitors

Biologic DMARDs used to treat AxSpa include:4

  • Adalimumab (Humira®)
  • Certolizumab (Cimzia®)
  • Etanercept (Enbrel®)
  • Golimumab (Simponi®)
  • Infliximab (Remicade®)

IL17 inhibitors include:

  • Ixekizumab (Taltz®)
  • Secukinumab (Cosentyx®)

What are the possible side effects of biologics?

Side effects can vary depending on the specific drug you are taking. The common side effects of biologics include:2-4

  • Rash
  • Nausea or vomiting
  • Injection site reactions (redness, itching, swelling)
  • Upper respiratory infection
  • Sinus infection

These are not all the possible side effects of biologics. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with biologics.

Things to know about biologics

Since they decrease inflammation and immune system response, biologics can increase the risk of infection. Serious infections can become life-threatening. Do not start taking a biologic if you have an active infection.2,4

Before you start a biologic, your doctor may test you for tuberculosis (TB) and hepatitis B. Starting a biologic when you have TB or hepatitis B can lead to severe infection. If you are at high risk for infection on a biologic, you may need to take other drugs alongside it. If you get fevers, chills, muscle aches, or other symptoms of an infection, talk with your doctor right away.2,4

Biologics may not be right for everyone. Do not take these drugs if you have:2,4

  • An active infection
  • Chronic liver disease
  • Immune system disorders
  • Low white blood cell counts (leukopenia)
  • Bone marrow hypoplasia

Biologics can also impact a person’s ability to safely get live vaccines. However, most vaccines are not live and can still be received. Talk with your doctor before starting a biologic if you have recently had or will soon get a vaccine.2,4

Before beginning treatment for AxSpa, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

Additional therapies

Other drugs besides biologic DMARDs may be used to help treat AxSpA spectrum conditions. Non-drug treatments like physical therapy and lifestyle changes may also be used to treat AxSpa.

Talk with your doctor about the range of treatments available for your symptoms and which treatments are right for you.

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