This is a primer meant to introduce you to a broad class of medicines we call “biologics” or “biosimilars.”
Disease Modifying Anti Rheumatic Agents
DMARD means disease modifying antirheumatic agent. And biologic refers to the similarity these molecules have to those in our bodies, more specifically antibodies.
Biologic agents are a pharmacologic treatment your rheumatologist employs in combatting your chronic disease.
Some of these diseases have faces and labels like rheumatoid arthritis, lupus, sjogren’s and ankylosing spondylitis. These diseases in part involve the dysregulation of your immune system and the text messages it secretes called cytokines. These text messages bind receptors, which you can sort of think of as an inbox for that text message, in and outside your cells and perpetuate this chronic inflammatory response.
Killing the messenger
There’s a lot of different biologics, but the principle is the same – seek and destroy the text message or the inbox.
These drugs are the go-tos when your rheumatologist uses their mostly cookie-cutter, insurance company governed approach to manage your disease. Crazy, huh? It’s almost like the insurance companies are practicing medicine. A discussion for another time.
You’re prescribed these when the first line treatments fail – methotrexate, plaquenil, sulfasalazine, azathioprine and others.
Do they work?
No doubt, these biologic DMARDS can make a HUGE difference, I’ve seen it. And for that reason, it would be silly for us to write them off entirely. But they carry risk of side significant side effects.
For others, they don’t seem to do squat. I had a patient this morning tell me she’s rotated through several. Enbrel, Humira, Simponi, Cimzia, Enbrel, Cosyntex and then back to Enbrel. Yes… that was Enbrel three times!
For those they do seem to help, they are effectively hurting certain arms of your immune system that defend your body, and so you’re rendered more susceptible to potentially dangerous infections.
And despite what your rheumatology wizards are saying about the lack of cancer risk, the jury is definitely still out on that one.
The reality is they most likely won’t be an ideal long-term solution for most folks. They’re a better transient solution while you do the things you need to do to get your disease into remission in a healthier way. The latter of which is definitely a reality.
Stay tuned, we’ll be taking a deep dive into the world of biologics in future content.