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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. These include ibuprofen (Advil, Motrin, and generics, naproxen (Aleve, Naprosyn, and generics), corticosteroids such as prednisone, and nonbiologic DMARDs, including hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine), minocycline (Dynacin, Minocin), and methotrexate (Rheumatrex). 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 may be time to try a biologic. Between 40 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 for the condition. None are available as generics, so they are all very expensive, with some costing more than $2,800 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 Health Best Buy Drugs:
  • Adalimumab (Humira)
  • Etanercept (Enbrel)
  • Abatacept (Orencia)

Studies show that these three medications are as effective or better than the other biologics for relieving rheumatoid arthritis symptoms. They also have better side effect profiles than some of the other biologics.

The side effects profile is a very important factor in choosing a biologic. The vast majority of people (up to 97 percent) treated with these medications experience at least one side effect, which can range from mild to serious to life-threatening. The potentially life threatening side effects include infections such as tuberculosis, cancer, serious damage of blood cells, and allergic reactions and convulsion following the infusion of a biologic.

 
CR BEST BUY Generic Name and Dose Brand Name Frequency of Use Average Monthly Cost1 Compare Prices
CR Best Buy Abatacept 10 mg/kg2 Orencia Every 4 weeks $1,860
CR Best Buy Adalimumab 40 mg, injectable kit Humira  Every other week $2,022
CR Best Buy Adalimumab 40 mg, pen injector  Humira Every other week   $2,034 
  Anakinra 100 mg, disposable syringes  Kineret  Daily  $1,205 
  Certolizumab 400 mg, injectable kit  Cimzia  Once a month  $915 
  Certolizumab 400 mg, prefilled syringe  Cimzia  Once a month  $933 
CR Best Buy Etanercept 25 mg, prefilled syringe  Enbrel  Twice a week  $2,648 
CR Best Buy Etanercept 50 mg, prefilled syringe  Enbrel  Once a week  $2,784 
CR Best Buy Etanercept 25 mg, injectable kit  Enbrel Twice a week  $2,113 
CR Best Buy Etanercept 50 mg, pen injector  Enbrel  Once a week  $2,126 
  Infliximab 5 mg/kg2  Remicade  Every 8 weeks3  $20344
  Rituximab 1,000 mg  Rituxan  Every 24 weeks3  $1,1224
1. Prices are derived from national average retail costs for April 2010, rounded to the nearest dollar. Information is derived by Consumer Reports Health Best Buy Drugs from data provided by Wolters Kluwer Pharma Solutions. Wolters Kluwer 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.

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