The following are targeted biologics approved for rheumatoid arthritis. Targeted means these drugs dampen a particular part of the body’s overactive inflammatory process.
Some of the biologics will not work for you although they work for some other people. Some biologics work for a short time then stop working. Some biologics work for years then seem to stop working suddenly. Sometimes an insurance company will stop covering certain biologics and insist a patient use a limited selection from their formulary. Some people are affected by the possible, serious side effects of these drugs. These complications happen to somebody so pay attention when your doctor briefly mentions them. Doctors do not know which drugs will work for you. Docs give it their best shot. It is trial and error. There is no system to finding the biologic that will work for you. This is the current medical scenario. In this article we will discuss Rituxan and Orencia.
In 1982, Rituxan was created by Ronald Levy for the express purpose of targeting malignant B cells. Rituxan affects the CD20, a transmembrane protein present on the surface of all B-cells. In 2006, the FDA approved Rituxan, manufactured by Genentech, to treat rheumatoid arthritis when used in combination with methotrexate. Before Rituxan can be used, a TNF inhibitor needed to have been tried and failed. Rituxan works by reducing the inflammatory action of B cells.
- How drug is given Rituxan is given at a medical facility by infusion(IV) given over 3-5 hours. It is given in two doses two weeks apart. The effect may be sustained for 6 months to a year. It may be repeated four times a year if needed.
- Common Side effects: The most common side effects are infusion reactions, infection, body aches, tiredness, nausea.
- BLACK BOX WARNING for Rituxan states “Warning: Fatal infusion reactions, severe mucocutaneous reactions, Hepatitis B virus reactivation and progressive multifocal leukoencephalopathy”
- Additional serious side effects Rituxan may cause serious infections, heart problems, kidney problems, stomach, and serious bowel problems.
- Pregnancy and lactation A person should not become pregnant during or for twelve months after the last dose of Rituxan. A woman should not breast feed during or for six months after the last dose of Rituxan.
Orencia (Abatacept )
Orencia was developed by the American drug company Bristol-Myers Squibb. It was FDA approved in 2005 for RA. It is a successful biologic that depresses the action of the immune system’s T-cells.
- How it is given Orencia is administered IV once a month or subcutaneously once a week.
- Common Side effects The most common side effects of Orencia are upper respiratory infections, such as common cold and sinus infection, sore throat, headache, and nausea.
- Black box warning There is no black box warning for Orencia.
- Serious side effects Infection is potentially a serious and common complication of the biologic medications. Orencia depresses the immune system. The most common serious infections involving Orencia are pneumonia and sepsis. Severe allergic reaction has occurred. Hepatitis B virus reactivation is a possibility. COPD patients on Orencia have more adverse events than those without COPD.
- Pregnancy and lactation Effects of Orencia on the fetus during pregnancy and in breast milk are unknown.
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