Biologic Agents

[Guest guest]

These articles are an educational supplement brought to you by the Arthritis

Society, Pharmacia Canada Inc. and Pfizer Canada Inc.

Hope you enjoy,

Marilyn

BIOLOGIC AGENTS:

Biologic drugs get their name because they have been designed specifically to

modify the " biologic response " that causes the inflammation in diseases like

rheumatoid arthritis. Like DMARDS, these medications work to decrease

inflammation in order to prevent the damage that can occur from long standing

inflammation.

The first biologic available in Canada is Etanercept (Enbrel), and the second is

Infliximab (Remicade). These medications target a molecule called tumour

necrosis factor (TNFa). By stopping the action of TNF, these medications

dramatically reduce the pain and swelling caused by inflammatory arthritis.

Although these medications were developed for the treatment of rheumatoid

arthritis, doctors are currently doing studies to see if these drugs will be

used for the treatment of other types of inflammatory arthritis as well.

HOW QUICKLY WILL THE BIOLOGIC AGENTS WORK?

Biologics work much more quickly than DMARDS. Patients may start to notice an

improvement in their arthritis within a few days to a week.

WHAT DO I NEED TO KNOW BEFORE STARTING ONE OF THESE BIOLOGIC AGENTS?

Both infliximab and etanercept should be avoided in patients who have active

infection. Your doctor will screen you for any infections (such as TB) before

starting the medication. If you develop an infection while on these

medications, you should contact your doctor immediately because the biologic

agent may need to be stopped. These medications should not be used in anyone

with disorders of the central nervous system such as multiple sclerosis,

myelitis and optic neuritis.

INFLIXIMAB:

This medication is often administered in hospital as an intravenous (IV)

infusion, which takes about two hours to complete. The infusion is repeated in

two weeks, then one month later and every two months after that. This drug

works best in the long term when used in combination with Methotrexate.

Side effects are rare but may include " cold " symptoms, cough, sinusitis and

headache. If you have any symptoms while on infliximab, you should tell your

doctor immediately.

ETANERCEPT:

Etanercept is given twice weekly by a small needle just underneath the skin

(called subcutaneous injection). Your doctor can teach you how to do this

injection by yourself. Some patients will experience some redness, pain or

swelling at the site of the injection. This is not a serious side effect, but

you should discuss it with your doctor.

MONITORING SIDE EFFECTS:

Most DMARDS, biologic agents and even NSAIDS will require some monitoring. Some

of these medications can lower the production of white blood cells or platelets,

others can affect how your liver or kidneys work. With regular monitoring, your

doctor can detect changes early and alter your dose or switch your medication.

Without this critical information, some arthritis treatments -- DMARD therapy in

particular -- can be dangerous. Keep your appointments faithfully. Ask your

doctor to explain the different tests, their purpose and how to interpret them.

Understanding these tests and their results can help reduce your anxiety and put

adjustments to your medication regimen into perspective.