Biologic Agents and the Treatment of Autoimmune Disorders
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The immune system plays a vital role in keeping the body healthy. It is made up of a complex network of cells and organs that work together to defend the body against foreign invaders.

While traditional pharmaceuticals are made up of chemicals, biologic agents are actually developed using proteins from living cells. They are designed to act on different parts of the inflammatory system in order to evoke specific, targeted effects.

Biologic Agents and the Treatment of Autoimmune Disorders
In autoimmune disorders, the immune system is overactive and destroys not only foreign substances, but also the body’s own tissues. The goal of biologic therapy is to slow or block specific components of the immune system and halt tissue destruction.

Autoimmune disorders treated with biologic agents include:

  • Psoriasis—A chronic skin disorder that not only causes skin lesions, but also problems with the joints, fingernails and toenails, genitals, and inside of the mouth. In psoriasis, certain immune cells become overactive, which results in psoriatic lesions developing on the skin and arthritis symptoms developing in the joints.
  • Rheumatoid arthritis (RA)—A chronic inflammation of the lining of the joints that results in pain, stiffness, swelling, damage, and loss of function. In RA, the immune system initiates chronic inflammation of the lining of the joints.
  • Multiple sclerosis (MS)—A chronic debilitating disease in which the immune system attacks the coating (called myelin) of the nerve fibers in the brain and spinal cord. This causes inflammation and injury to the sheath and the nerves. It can cause problems with coordination, balance, speaking, and walking.
  • Inflammatory bowel disease—A chronic disease that results in inflammation, ulcers, and bleeding of the intestines. The course of the disease is generally marked by flare-ups between periods of remission. The two types are Crohn's disease and ulcerative colitis.
Side Effects of Biologic Agents
Side effects depend on many factors such as the type of biologic, dosage, route of administration, schedule, and how your body reacts to the biologic agents. Some possible side effects of biologic therapies are:

  • Infection
  • High blood pressure
  • Lightheadedness
  • Flu-like symptoms, such as fever, chills, muscle and joint aches
  • Nausea and/or vomiting
  • Redness, rash, and/or pain at injection site
  • Headache
  • Allergic reaction
  • Increased risk of Hodgkin’s and non-Hodgkin’s lymphoma and other types of cancer in children and teens taking TNF inhibitors
  • Possible reactivation of latent tuberculosis infections with TNF inhibitors
If your doctor recommends biologic therapy, ask about which specific side effects you may experience.

A Step Forward in Medicine
Many biologic agents have been approved by the FDA (see the following table), and many more are under development.

Examples of Approved Biologic Agents for Autoimmune Disorders

Biologic Agent

Disease State

alefacept

psoriasis

ustekinumab

psoriasis

etanercept

psoriatic arthritis; rheumatoid arthritis; juvenile rheumatoid arthritis and more

adalimumab

rheumatoid arthritis, Crohn's disease, psoriasis and more

infliximab

rheumatoid arthritis; Crohn’s disease; ulcerative colitis

anakinra

rheumatoid arthritis

interferon beta

multiple sclerosis

certolizumab

Crohn's disease; rheumatoid arthritis; psoriatic arthritis

vedolizumab

Crohn's disease; ulcerative colitis




RESOURCES:
National Multiple Sclerosis Society

National Psoriasis Foundation

CANADIAN RESOURCES:


References:
Autoimmune diseases fact sheet. Office on Women's Health website. Available at: http://www.womenshealth.gov/publications/our-publications/fact-sheet/autoimmune-diseases.html. Updated July 16, 2012. Accessed July 18, 2014.

Biologic disease-modifying antirheumatic drugs (DMARDs) for rheumatoid arthritis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 9, 2014. Accessed July 18, 2014.

Donahue KE, Gartlehner G, Jonas DE, et al. Systematic review: comparative effectiveness and harms of disease-modifying medications for rheumatoid arthritis. Ann Intern Med. 2008; 148.

Efalizumab (marketed as Raptiva) information. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm133337.htm. Updated June 14, 2013. Accessed July 18, 2014.

Keystone EC, et al. Once-weekly administration of 50 mg etanercept in patients with active rheumatoid arthritis: results of a multicenter, randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2004;50(2):353-63.

Moderate to severe psoriasis: biologic drugs. National Psoriasis Foundation Web site. Available at: http://www.psoriasis.org/sublearn03_severe_biologics. Accessed July 18, 2014.

National drug code directory. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/InformationOnDrugs/ucm142438.htm. Updated July 18, 2014. Accessed July 18, 2014.

Last Reviewed July 2014



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