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.