From the Guidelines
Biologics are a crucial treatment option for various systemic rheumatic diseases, including rheumatoid arthritis, axial spondyloarthritis, and psoriatic arthritis, and should be considered as a first-line therapy in patients who do not respond to conventional treatments, as recommended by recent guidelines 1. The development of biologics has revolutionized the treatment of these diseases, offering innovative mechanisms of action that target specific molecular or cellular targets directly involved in disease pathogenesis.
- Biologics include monoclonal antibodies, such as adalimumab, infliximab, and etanercept, which are commonly used to treat rheumatoid arthritis, psoriasis, and inflammatory bowel disease.
- Other classes of biologics include IL-17 inhibitors, such as Cosentyx and Taltz, and IL-23 inhibitors, such as Tremfya and Skyrizi.
- The British Association of Dermatologists guidelines for biologic therapy in psoriasis recommend the use of biologics, such as adalimumab, etanercept, and infliximab, in patients with moderate to severe psoriasis who have not responded to conventional treatments 1.
- The guidelines also emphasize the importance of screening patients for tuberculosis and hepatitis before starting biologic therapy, and avoiding live vaccines during treatment.
- The use of biologics has been shown to improve quality of life and reduce disease activity in patients with rheumatoid arthritis and psoriatic arthritis, and should be considered as a treatment option in patients who have not responded to conventional therapies 1.
- In terms of treatment strategies, the guidelines recommend a treat-to-target approach, with the goal of achieving sustained clinical remission or low disease activity.
- The availability of biosimilars has also increased access to biologic therapies, offering a more affordable treatment option for patients 1.
From the Research
Definition and Types of Biologics
- Biologics are a diverse group of drugs that act directly on the immune system, including cytokines and monoclonal antibodies 2
- They can be genetically engineered versions of naturally occurring substances or novel compounds used for the treatment of cancer and non-oncology diagnoses 2
Biologics for Rheumatoid Arthritis
- Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab, and abatacept are biologic disease-modifying antirheumatic drugs (bDMARDs) used for the treatment of rheumatoid arthritis 3
- The clinical effectiveness and cost-effectiveness of these bDMARDs compared with each other and conventional disease-modifying antirheumatic drugs (cDMARDs) have been assessed in a systematic review and economic evaluation 3
- The results showed that bDMARDs appear to have cost per quality-adjusted life-year (QALY) values greater than the thresholds stated by the National Institute for Health and Care Excellence for interventions to be cost-effective 3
Biologics for Psoriasis and Psoriatic Arthritis
- SDZ-ADL, an adalimumab biosimilar, has been shown to be effective in improving quality of life and patient-reported outcomes in patients with moderate-to-severe chronic plaque psoriasis and psoriatic arthritis 4
- Treatment with SDZ-ADL resulted in comparable improvements in patient-reported outcomes and quality of life scores across the three diseases, psoriasis, psoriatic arthritis, and rheumatoid arthritis 4
Safety and Monitoring of Biologics
- Biologic therapies may increase the risk of reactivation of latent and chronic infections, such as tuberculosis and hepatitis B virus 5
- Baseline tuberculosis tests are the only screening tests supported with strong evidence, while high-grade evidence for hepatitis B virus screening tests is lacking 5
- Nursing management of biologic therapy includes monitoring for specific side effects and providing patient education on the potential risks and benefits of these agents 2