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Biologics: Summary of Recommendations

Rheumatoid arthritis, which afflicts more than 1.3 million adults in the United States, can leave you with swollen, stiff and painful joints and can lead to irreversible joint damage if left untreated. Injectable drugs referred to as biologic DMARDs (Disease-Modifying Antirheumatic Drugs)—or simply, biologics—can help relieve these symptoms and may help prevent further joint damage. But they can cause serious side effects, so they should not be used until after you have tried other therapies.

If you have been newly diagnosed with rheumatoid arthritis, studies show that other, less costly and safer medications work just as well as biologics, so you should try those first. These include nonbiologic DMARDs, such as hydroxychloroquine (Plaquenil or generic), sulfasalazine (Azulfidine or generic), minocycline (Dynacin, Minocin, or generic), and methotrexate ([Trexall and generic). In addition, your doctor is also likely to recommend pain relievers, such as ibuprofen (Advil, Motrin, and generics) and naproxen (Aleve, Naprosyn, and generics), and corticosteroids, such as prednisone. You should also follow an exercise program because studies show such programs improve function in people with rheumatoid arthritis.

If those therapies fail to provide you with enough symptom relief, then it might be time to try a biologic. Between 30 to 70 percent of people who have not benefitted from other rheumatoid arthritis medications experience some measure of relief from biologics. Nine different biologics are available to treat the symptoms of rheumatoid arthritis, but they are not a cure. None are currently available as generics, so they are all very expensive, with some costing more than $2,600 per week.

  Taking into account the evidence for effectiveness and safety, as well as cost, if you need a biologic drug to treat your rheumatoid arthritis, we have chosen the following as Consumer Reports Best Buy Drugs:
  • Abatacept (Orencia)
  • Adalimumab (Humira)
  • Etanercept (Enbrel)

Studies show that these three medications are as effective as the other biologics for relieving rheumatoid arthritis symptoms, and they also may have lower rates of people who stop taking them due to side effects compared to some of the other biologics.

However, all of the biologics can cause side effects. In studies, about 13 percent of people who took a biologic experienced serious or life-threatening side effects (but many people, about 12 percent, who received a placebo also had serious side effects). Minor side effects, such as abdominal pain, nausea, and injection site reactions, can also occur, but usually do not require stopping or changing drugs. The potentially life-threatening side effects include serious bacterial infections, such as tuberculosis, skin cancer, lymphoma, and allergic reactions following infusion.

 
CR BEST BUY Generic Name and Strength Brand Name Frequency of Use Average Monthly Cost1
Abatacept 125 mg/mL2 Orencia Every 4 weeks for intravenous injection
Once a week for subcutaneous injection
Given every 4 weeks: $2,215
Given every week: $2,737
Adalimumab 40 mg, injectable kit Humira Every week or every other week Given every other week: $2,632
Given every week: $5,264
Adalimumab 40 mg, pen injector Humira Every week or every other week Given every other week: $2,654
Given every week: $5,308
  Anakinra 100 mg, disposable syringes Kineret Daily $1,796
  Certolizumab 400 mg, injectable kit Cimzia Every other week $2,739
Etanercept 25 mg, prefilled syringe Enbrel Once a week $1,197
Etanercept 50 mg, prefilled syringe Enbrel Once a week $2,444
Etanercept 50 mg, pen injector Enbrel Once a week $2,690
  Golimumab 50 mg, prefilled syringe Simponi Every 4 weeks $2,880
  Golimumab 50 mg, pen injector Simponi Every 4 weeks $2,864
  Infliximab 100 mg2 Remicade Every 4 to 8 weeks3 Given every 8 weeks: $1,378D
Given every 4 weeks: $2,756D
  Rituximab 10 mg/mL Rituxan Every 24 weeks3 $1,3244
  Tocilizumab 200 mg/10 mL Actemra Every 4 weeks $1,7975
  Tocilizumab 400 mg/20 mL Actemra Every 4 weeks $1,8255
1. Prices are derived from national average retail costs for December 2012, rounded to the nearest dollar. Information is derived by Consumer Reports Best Buy Drugs from data provided by Wolters Kluwer Pharma Solutions, which is not involved in our analysis or recommendations.

2. Calculated price is based on an assumed body weight of 75 kg (165 pounds).

3. Refers to an average interval; number of infusions required varies among people.

4. A typical course requires closer intervals in the beginning. Average costs during the first year of treatment, therefore, may be substantially higher.

5. Price might be unreliable because it is based on less than 20 prescriptions.