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Starting a Biologic: What To Expect

Posted on February 04, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Joan Grossman

  • Before starting a biologic for axial spondyloarthritis (axSpA), you will undergo blood tests and be screened for infections.
  • Biologics are taken by injection — either as an intravenous infusion in a clinic or self-injection under the skin at home.
  • Talk to your doctor about potential side effects and when you might expect to notice improvement in your symptoms.

Biologic drugs are medications that target immune system proteins involved with inflammation in axial spondyloarthritis. Sometimes referred to as spondylitis or spondyloarthritis, axSpA is an inflammatory arthritis that affects the spine. Types of axSpA include ankylosing spondylitis (called AS or radiographic axSpA) and nonradiographic axSpA.

Biologic therapy may be appropriate for people with spondylitis when nonsteroidal anti-inflammatory drugs (NSAIDs) or conventional disease-modifying antirheumatic drugs (DMARDs) such as methotrexate or sulfasalazine have not provided adequate relief from symptoms. Read more about conventional vs. biologic DMARDs for spondylitis.

If you are considering starting a biologic to treat your spondylitis, it’s a good idea to learn about what to expect in terms of screening, taking biologics, potential side effects, and when you might notice improvement.

Screening Tests

Your doctor will order various tests before starting you on a biologic drug. Biologic drugs suppress aspects of the immune system, which causes an increased risk for infection. For this reason you will need to be screened for any “silent” infections for which you might not have symptoms. If you have an existing infection, it will usually need to be treated prior to beginning biologic treatment.

You will likely need blood tests to screen for:

  • Tuberculosis (TB), possibly with a chest X-ray and skin test
  • Hepatitis B and hepatitis C

Additional blood tests will establish baseline levels that will be monitored for abnormalities while you are taking a biologic. Baseline tests typically include:

  • A liver enzyme test to measures liver function
  • A complete blood count (CBC) to measure red blood cells, white blood cells, hemoglobin, hematocrit, and platelets
  • Levels of lipids, or blood fats such as cholesterol, due to the risk for heart disease

Administration, Doses, and Schedules for Biologics

There are several different types of biologic drugs that are used in the treatment of spondylitis. The method of administration, dosage, and scheduling can vary depending on the drug. Your rheumatologist and health care team will discuss the proper usage for any biologic drug recommended for you.

Biologic Drug Administration

Biologic drugs consist of complex proteins that cannot be effectively absorbed in the digestive system if taken orally. Currently, they must be taken by intravenous (IV) infusion or subcutaneous injection.

IV infusions are given in a clinical setting by health care providers through a needle inserted into a vein. Subcutaneous injections are self-administered at home using prefilled syringes and auto-injectors that release the drug under the skin. If you will self-inject your biologic at home, make sure your doctor or nurse gives you training on how and where to inject. Ask as many questions as you need to. You should be able to do your first self-injection at the clinic with their supervision.

Read more about intravenous infusion vs. subcutaneous self-injection.

Dosing of Biologic Drugs

Dosage for biologic drugs typically begins with more frequent loading doses and then tapers down. Loading doses and schedules can vary among medications.

Biologic Drug Scheduling

Biologic drugs are administered on a variety of schedules. In some cases, higher doses may be given less frequently by infusion, while self-injected drugs with lower doses might be taken more often.

Be sure to discuss scheduling in detail with your rheumatologist. It is essential that you thoroughly understand your treatment plan and carefully adhere to the specific schedule to get the most benefit from the drug.

Common Side Effects

When taking a biologic drug, you have a higher risk of infection. Biologic medication is designed to suppress specific aspects of the immune system that cause chronic inflammation in people with spondylitis.

Other common side effects for biologics include reactions at the injection site, headache, and nausea. Talk to your doctor about common side effects to get medical advice about how best to manage them.

Signs of serious infection should be reported to your rheumatologist and health care providers immediately. Tell your doctor if you experience any of the following symptoms:

  • Fever or chills
  • Shortness of breath
  • Muscle pain or tingling
  • Rash or painful sores
  • Diarrhea or abdominal pain
  • Abnormal urination

How Quickly Do Biologics Work?

Biologic drugs may take time to start taking effect. Some people with spondylitis might feel better after their first treatment. But more often than not, biologic drugs can take several weeks or months to take effect. With biologic drugs, it’s important to maintain treatment and be patient as the medication starts to work. Talk to your doctor about when you might expect to notice improvement.

Talk With Others Who Understand

On MySpondylitisTeam, the social network for people with spondylitis and their loved ones, more than 76,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

Are you considering biologic treatment? What questions or concerns do you have? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Overview of Types of Spondylitis —Spondylitis Association of America
  2. Biological Therapies for Spondyloarthritis — Therapeutic Advances in Musculoskeletal Disease
  3. 9 Medical Tests You Need Before Starting a Biologic Drug — CreakyJoints
  4. 2019 Update of Eular Recommendations for Vaccination in Adult Patients With Autoimmune Inflammatory Rheumatic Diseases — Annals of the Rheumatic Diseases
  5. Biologics — Arthritis Foundation
  6. Complete Blood Count (CBC) — Mayo Clinic
  7. Cardiac Involvement in Ankylosing Spondylitis — Journal of Clinical Medicine Research
  8. The British Society for Rheumatology Biologic DMARD Safety Guidelines in Inflammatory Arthritis — Executive Summary — Rheumatology
  9. Medications Used To Treat Ankylosing Spondylitis and Related Diseases — Spondylitis Association of America
  10. Patient Experience With Intravenous Biologic Therapies for Ankylosing Spondylitis, Crohn’s Disease, Psoriatic Arthritis, Psoriasis, Rheumatoid Arthritis, and Ulcerative Colitis — Patient Preference and Adherence
  11. Recent Advances in the Oral Delivery of Biologics — The Pharmaceutical Journal
  12. The Pharmacological and Clinical Aspects Behind Dose Loading of Biological Disease Modifying Anti-rheumatic Drugs (bDMARDs) in Auto-Immune Rheumatic Diseases (AIRDs): Rationale and Systematic Narrative Review of Clinical Evidence — BMC Rheumatology
  13. 2019 Update of the American College of Rheumatology/ Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis — American College of Rheumatology
  14. Giving Yourself Biologic Injections: 23 Practical Tips To Try — CreakyJoints
  15. Side Effects of Biologic Medications — Johns Hopkins Arthritis Center
  16. Signs and Symptoms of Infection With Biologic Medications — Johns Hopkins Arthritis Center
  17. Differences in Biologics for Treating Ankylosing Spondylitis: The Contribution of Network Meta-Analysis — European Review for Medical and Pharmacological Sciences

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Joan Grossman is a freelance writer, filmmaker, and consultant based in Brooklyn, NY. Learn more about her here.

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