Biologics SECTION:  
Biologic Response Modifiers How to read this chart  Close this window
DRUG BRAND(S) DOSAGE SPECIAL
INSTRUCTIONS		 POSSIBLE
SIDE EFFECTS		 BE AWARE
DRUG BRAND(S) DOSAGE SPECIAL
INSTRUCTIONS		 POSSIBLE
SIDE EFFECTS		 BE AWARE
TNF Inhibitors
Adalimumab Humira For adults with RA, ankylosing spondylitis or psoriatic arthritis: 40 mg Humira once every other week when given with methotrexate. Some patients with RA not also taking methotrexate may benefit from a dosage increase to weekly 40-mg injections. Drug must be refrigerated but not frozen prior to use. Comes in prefilled syringes and may be injected into the thigh, abdomen or upper arm.

Redness and pain, itching, swelling and/or bruising at the injection site; upper respiratory infection; if allergic to latex, do not handle needle cover.

 For all biologics:
RA carries a higher risk of infection and cancer, particularly lymphoma. It is uncertain whether biologics increase lymphoma risk. Do not start treatment (or discontinue it) if you have a serious or recurrent infection (such as pneumonia). Do not take live vaccines; the pneumonia vaccine (Pneumovax) or flu vaccine can be safely given.

For adalimumab, etanercept and infliximab:
Let your doctor know if you have or have had one of the following: active infection, recurrent infection, exposure to tuberculosis or a positive skin test for tuberculosis; serious nervous system disorder, such as multiple sclerosis, seizures, myelitis or optic neuritis. Patients with congestive heart failure (CHF) should not be given adalimumab, etanercept or infliximab.

For etanercept and infliximab:
Rare reports of lupus (with symptoms such as rash, fever and pleurisy) have been linked to treatment with etanercept and infliximab. Lupus symptoms resolve when the medication is stopped. Multiple sclerosis has rarely developed in patients receiving etanercept or infliximab. Seizures have been reported with etanercept.

For infliximab:
Infusion reaction may be treated by slowing the speed of infusion or by pre-treatment with acetaminophen, antihistamine (Benadryl, Claritin) or steroid medication (hydrocortisone, prednisone).

For anakinra:
Serious infections, such as pneumonia, occur in approximately 2 percent of patients taking anakinra. Inform your doctor if you have a current infection or history of serious infection.

For abatacept:
Serious infections may occur. Concurrent use with methotrexate or another DMARD is tolerated. RA patients who also have chronic obstructive pulmonary disease (COPD) and take abatacept should have their respiratory status monitored. Prior to initiating therapy, patients should be tested for tuberculosis.

For rituximab:
Do not have infusion if you have a serious or recurring infection. Undergo testing for hepatitis B, and let your doctor know if you have heart or lung disease.

Etanercept Enbrel 50 mg per week given as one injection beneath the skin using a 50 mg/mL single-use prefilled syringe or pen device. The 25-mg vials are still available. Two 25-mg injections should be given on the same day or three to four days apart. Drug must be refrigerated prior to use. Mix by injecting liquid into the vial containing medicine in powder form. Do not shake, instead swirl medicine prior to injection. May be injected into the thigh, abdomen or upper arm.

Redness and pain, itching, swelling and/or bruising at the injection site; headache; sinus infection; if allergic to latex, do not handle needle cover.
Infliximab Remicade Dose is based on body weight. For RA: 3 mg/kg; should be given in combination with methorexate. For psoriatic arthritis: 5 mg/kg; can be given with or without methotrexate. For ankylosing spondylitis: 5 mg/kg. Drug is given intravenously (IV) during a 2-hour infusion done in a doctor’s office, clinic or hospital. For RA and psoriatic arthritis, infusions given at 0, 2 and 6 weeks; then every 8 weeks. For ankylosing spondylitis, infusions at 0, 2, and 6 weeks and then every 6 weeks. Infusion reactions (occurring during or shortly after the infusion), including chest pain, change in blood pressure, difficulty breathing and hives; redness, pain, swelling or itching at injection site; sinus infection
Selective B-Cell Inhibitor
Rituximab Rituxan Two 1,000-mg doses given two weeks apart. Safety of retreatment is still being investigated. In clinical trials of people with RA, most patients who received additional courses did so 16 to 24 weeks after the previous course. Drug is infused intravenously in doctor’s office, clinic or hospital. Intravenous corticosteroids should be administered 30 minutes prior to the infusion to reduce the incidence and severity of infusion reactions. Common side effects: abdominal pain, chills/shivering, fever, headache, infection, itching. Serious side effects, some of which could be life threatening, include infusion reactions, tumor lysis syndrome and severe skin reactions.
IL-1 Inhibitor
Anakinra Kineret 100 mg given once daily by subcutaneous (beneath the skin) injection using a prefilled syringe; 100 mg every other day for patients with severe kidney disease. Refrigerate prior to use. Prefilled syringes can be self-injected with or without the aid of an automatic injection device (SimpleJect) available from manufacturer. Do not shake. May be injected into the thigh, upper arm or abdomen. Try to administer around same time every day. Injection site reactions (usually occurring during the first 4 to 6 weeks of use), including redness, swelling, pain and bruising; low white blood cell count; upper respiratory infection
Selective Costimulation Modulator
Abatacept Orencia Dose is based on body weight and ranges from 500 mg to 1,000 mg per treatment for most patients. After three initial infusions at 0, 2 and 6 weeks, infusions are repeated every 4 weeks. Drug is given intravenously through a vein in the arm during a 30-minute infusion done in a doctor's office, clinic or hospital. Cough; dizziness; headache; serious infections; sore throat. A small percentage of patients experience an infusion reaction within an hour of starting the infusion, consisting of mild-to-moderate symptoms such as changes in blood pressure, cough, flushing, itching, nausea, shortness of breath, rash, wheezing.