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Biologic Agents

Medications for Scleroderma, Arthritis, Autoimmune and Rheumatic Diseases
This page was written by Janey Willis. See Disclaimer.
Overview of Biologic Agents
Alemtuzumab (Campath)
Etanercept (Enbrel)
Infliximab (Remicade)
Rituximab (Rituxan)
TNF Inhibitors

Overview

Biologics or biologic agents are biologic response modifying agents that block specific pathways and signals of inflammation. Some of the biologics used to treat rheumatic diseases include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), abatacept (Orencia), and rituximab (Rituxan). (Also see: What is Scleroderma?, Medical Overview, and Medications for Scleroderma, Arthritis, Autoimmune and Rheumatic Diseases)
Different biologics block different arm of the immune system. For example, etanercept, infliximab, and adalimumab block tumor necrosis factor (TNF), abatacept blocks an interaction between T cells and macrophages, and rituximab effectively eliminates B cells for several months.
Indirect Comparison Between Subcutaneous Biologic Agents in Ankylosing Spondylitis (AS). Golimumab, compared to placebo, may be the drug that provides the highest probability of achieving ASAS20 response in AS patients naive to biologic treatments at 12 weeks. PubMed, Clin Drug Investig, 2014 Nov 12.
New treatments for inflammatory rheumatic disease. This article describes the new and upcoming treatment options for rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus, and gout to dissect what we should be aware of when discussing these new and promising molecules. PubMed, Immunol Res, 2014 Nov 9.

Alemtuzumab (Campath)

FDA Alert: Alemtuzumab (marketed as Campath) Information. Three patients in a clinical study of the drug Campath for the treatment of Multiple Sclerosis (MS) developed severe idiopathic thrombocytopenic purpura (ITP). One of the patients died. U.S. Food and Drug Administration. 11/05.
Alemtuzumab (Campath): Side Effects. Safety data, except where indicated, are based on 149 patients with B-CLL enrolled in studies of Campath as a single agent administered at a maintenance dose of 30 mg intravenously three times weekly for 4 to 12 weeks. RxList.

Etanercept (Enbrel)

Enbrel. Enbrel (also known by its generic name etanercept) is a biologic medication approved in April 2004 by the U.S. Food and Drug Administration (FDA) for the treatment of moderate to severe plaque psoriasis and in January 2002 for the treatment of psoriatic arthritis. It is also approved for treating rheumatoid arthritis, juvenile rheumatoid arthritis and ankylosing spondylitis (arthritis affecting the spine). National Psoriasis Foundation.
Treatment of moderate rheumatoid arthritis with different strategies in a health resource-limited setting: a cost-effectiveness analysis in the era of biosimilars. This study explores the cost–effectiveness of reduced doses or discontinuation of etanercept biosimilar (Yisaipu) in patients with moderately active rheumatoid arthritis (RA). PubMed, Clin Exp Rheumatol, 12/01/2014. (Also see: Treatments for Rheumatoid Arthritis)

Infliximab (Remicade)

The effect of rituximab therapy on immunoglobulin levels in patients with multisystem autoimmune disease. In multi-system autoimmune disease, prior cyclophosphamide exposure and glucocorticoid therapy but not cumulative rituximab dose was associated with an increased incidence of hypogammaglobulinaemia and repeat dose rituximab therapy appears safe with judicious monitoring. PubMed, BMC Musculoskelet Disord, 2014 May 25;15(1):178.
Infliximab (Remicade). Patients treated with REMICADE are at increased risk for infections, including progression to serious infections leading to hospitalization or death. RxList.
An Open-Label Pilot Study Of Infliximab Therapy In Diffuse Cutaneous Systemic Sclerosis (dcSSc). In dcSSc infliximab did not show clear benefit at 26 weeks but was associated with clinical stabilisation and fall in two laboratory markers of collagen synthesis. The frequency of suspected infusion reactions may warrant additional immunosuppression in any future studies in SSc. C. P. Denton. Ann Rheum Dis, [2008]. (Also see: Scleroderma Treatments)

Rituximab (Rituxan)

Rituxan (Targeted B-cell Therapy). Indications and Uses. FDA Warning. Rituxan.com.
Rapid infusion with rituximab: short term safety in systemic autoimmune diseases. In practise, the rapid infusion was an easy to use regime and the second infusion is of time sparing significance to health professionals. No unexpected side effects were observed in relation to the accelerated regime. Rheumatol Int, 2011 Nov 9.
Efficacy And Safety Of Rituximab In Patients With Diffuse Scleroderma (SSc): An Up To 2 Years Follow Up Study. Results indicate that long term treatment with RTX may favorably affect lung function and skin fibrosis in patients with SSc. D. Daoussis. EULAR 2011 FRI0403. Ann Rheum Dis 2011;70(Suppl3):480.

TNF Inhibitors

Tumor Necrosis Factor (TNF) inhibitors include etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira)
Is there a role for TNFα antagonists in the treatment of Systemic Sclerosis (SSc)? Most of the experts do not recommend the routine use of TNF-α antagonists in systemic sclerosis. Arthritis might be a potential indication, although controlled clinical trials are needed before general recommendations can be given. Clin Exp Rheumatol, 2011 Mar-Apr;29(2 Suppl 65):S40-5.
 
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