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 (Azulfidine) 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.
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:
Additional blood tests will establish baseline levels that will be monitored for abnormalities while you are taking a biologic. Baseline tests typically include:
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 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.
Dosage for biologic drugs typically begins with more frequent loading doses and then tapers down. Loading doses and schedules can vary among medications.
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.
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:
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.
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