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  • Biologic Agents and the Treatment of Autoimmune Disorders

    Image for autoimmune disorder article
    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 : This is 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) : RA is 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) : MS is 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.

    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
    • Dizziness
    • Flu-like symptoms (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 him 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
    Brand name
    Biologic Agent
    Disease State
    Amevive
    alefacept
    psoriasis
    Stelara
    ustekinumab
    psoriasis
    Enbrel
    etanercept
    psoriatic arthritis; rheumatoid arthritis; juvenile rheumatoid arthritis and more
    Humira
    adalimumab
    rheumatoid arthritis, crohn's disease, psoriasis and more
    Remicade
    infliximab
    rheumatoid arthritis; Crohn’s disease
    Kineret
    anakinra
    rheumatoid arthritis
    Avonex, Rebif
    interferon beta
    multiple sclerosis

    RESOURCES

    National Multiple Sclerosis Society http://www.nationalmssociety.org/

    National Psoriasis Foundation http://www.psoriasis.org/

    The Arthritis Foundation http://www.arthritis.org/

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca/

    Healthy U http://www.healthyalberta.com/

    References

    Autoimmune diseases fact sheet. WomensHealth.gov website. Available at: http://womenshealth.gov/publications/our-publications/fact-sheet/autoimmune-diseases.cfm#h. Updated August 14, 2010. Accessed August 10, 2012.

    Biologic disease-modifying antirheumatic drugs (DMARDs) for rheumatoid arthritis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated June 27, 2012. Accessed August 7, 2012.

    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 August 21, 2008. Accessed August 7, 2012.

    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%5Fsevere%5Fbiologics . Accessed August 7, 2012.

    National drug code directory. US Food and Drug Administration website. Available at: http://www.accessdata.fda.gov/scripts/cder/ndc/default.cfm. Updated August 6, 2012. Accessed August 10, 2012.

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