Biologic drugs have been used to treat RA during the past ten years. and are typically used as second-line drugs for patients who do not respond to traditional DMARDs. Some biologics are used as first-line drugs for select patients with moderately to severely active RA. There are nine biologics which are used for the treatment of RA, with the first receiving FDA approval in 2001. A tenth biologic drug, Xeljanz (tofacitinib), was approved in November 2012 and should hit the market soon.
Traditionally, RA patients may be prescribed treatment with one or
more of the non-biologic DMARDs before receiving treatment with a
biologic drug (which is considered more aggressive). A recent
meta-analysis of 70 studies involving drugs used for RA compared the
effectiveness of various treatments and combination of treatments in
preventing joint erosion caused by RA as seen on x-ray image. One
outcome of the analysis revealed that combination treatment with 2
DMARDs plus periodic steroid treatment may be as effective as a biologic
agent plus methotrexate (Graudal, 2010).
Besides being very expensive, a drawback to the biologic medications
has been that they are given as subcutaneous injection (shot under the
skin) or intravenous (IV) infusion. However, many patients who fear
self-injections are able to learn to give themselves shots with
appropriate training and support.
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DMARDs, Biologics for RA, and Needle-Free Injections