Health and Fitness

How Do Biologics Work to Treat Autoimmune Diseases?

Each biologic works against a specific cytokine. But some autoimmune diseases are fueled by more than one cytokine. So how does your doctor know which one to choose?

“We don’t really have an easy mechanism to say, ‘If I have four or five cytokines that commonly cause an autoimmune disorder … it’s absolutely this cytokine,’” Dr. Frame says. The decision comes down to which biologic most people with your condition responded well to in studies, and your doctor’s preference, he adds. Your insurance coverage if you have it can also factor into the decision, Dr. Husni says.

What types of biologics are there?

Biologics are divided up into groups, or classes, based on the inflammatory pathway they target7. Each works by preventing a particular cytokine from causing inflammation. Below are the common biologic classes used to treat autoimmune diseases:

TNF inhibitors

What they target: These prevent the tumor necrosis factor protein from binding to its corresponding receptors and causing inflammation8.

Autoimmune diseases they commonly treat: Ankylosing spondylitis, Crohn’s disease, ulcerative colitis, psoriatic arthritis, rheumatoid arthritis

IL-1 inhibitors

What they target: interleukin-1, interleukin-6, interleukin-12 and interleukin-23

Autoimmune diseases they commonly treat: juvenile idiopathic arthritis

IL-6 inhibitors

What they target: interleukin-6

Autoimmune diseases they commonly treat: giant cell arteritis, juvenile idiopathic arthritis, rheumatoid arthritis

IL-17 inhibitors

What they target: interleukin-17

Autoimmune diseases they commonly treat: psoriasis, psoriatic arthritis, and ankylosing spondylitis 

IL-12 and IL-23 inhibitors

What they target: interleukin-12 and interleukin-23

Autoimmune diseases they commonly treat: psoriasis, psoriatic arthritis, Crohn’s disease

B-cell inhibitors

What they target: B cells

Autoimmune diseases they commonly treat: rheumatoid arthritis, lupus

T-cell inhibitors

What they target: T cells

Autoimmune diseases they commonly treat: rheumatoid arthritis

How do I take biologics?

Biologics are very sensitive to the acid in your stomach and can’t be taken orally like many conventional medications. “If you try to give most of these biologics orally, they will mostly be chewed up by the stomach acid,” Dr. Frame says. “We have to give them either through an IV directly into the blood, or injected under the skin,” he says.

How often you need treatment and the way you receive it depends on your type of autoimmune disease, and which biologic you take. For example, some medications can be self-administered through an injection under your skin weekly. Other drugs are given through an intravenous infusion monthly or every few months.

What about side effects?

Any drug you take can cause side effects, and biologics are no exception. It’s common to feel tired for a couple of days after your infusion or injection or to have headaches. Other side effects of taking a biologic include reactions near your injection site, a mild sore throat, and stomach pains.

Since these drugs work by dampening your immune system (which normally protects you against germs), you may be more susceptible to getting illnesses like the common cold. “We’re not wiping out [the immune system], but we’re lowering it. When you suppress it, you can get more infections,” Dr. Husni says. There’s also a chance that your body might mistake the biologic itself as a foreign invader and produce antibodies against it, which could make it less effective, according to the Mayo Clinic12. If that happens, you may need to try a new medication.

Biologics are complex drugs, and they can take some time to figure out. Getting familiar with how they work to reduce your symptoms can make you more comfortable with your treatment plan.

Sources:

1. U.S. Department of Health & Human Services, Autoimmune Diseases
2. Indian Journal of Dermatology, Biologics: Target-Specific Treatment of Systemic and Cutaneous Autoimmune Diseases
3. National Human Genome Research Institute, Lymphocyte
4. University of Michigan College of Pharmacy, David Frame, PharmD
5. The American Journal of Pathology, T-Cell-Mediated Autoimmunity
6. U.S. National Library of Medicine, Methotrexate
7. Current Pharmaceutical Biotechnology, Biologics in Inflammatory and Immune Mediated Arthritis
8. StatPearls, Tumor Necrosis Factor Inhibitors
9. Polish Archives of Internal Medicine: Biologic Agents and Small-Molecule Inhibitors In Systemic Autoimmune Conditions: An Update
10. Current Opinion in Immunology, Cell Targeted Therapies In Autoimmune Disease
11. International Journal of Cell Biology, Biologics for Targeting Inflammatory Cytokines, Clinical Uses, and Limitations
12. Mayo Clinic Laboratories, Biologics Management

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