Non-TNFi Biologics (Kevzara®, Stelara®, Cosentyx®, Orencia®, Actemra®, and Rituxan®)
There are other biologics that target the immune system in different ways from TNFi drugs. They interact with different kinds of white blood cells, such as T cells or B cells, in your immune system. They can also block chemicals called cytokines that cause inflammation.
White blood cells and cytokines are made by your immune system to fight off infection. But in arthritis, they may be out of control and cause inflammation. So these drugs can suppress specific parts of your immune system, ease inflammation, stop your disease’s progress, and ease your symptoms.
Non-TNFi biologics include Sarilumab (Kevzara®), Ustekinumab (Stelara®), Secukinumab (Cosentyx®), Abatacept (Orencia®), Tocilizumab (Actemra®), and Rituximab (Rituxan®).
Sarilumab (Kevzara®) is a biologic drug indicated for adults with rheumatoid arthritis.
It’s used in someone who either didn’t respond well to or couldn’t tolerate at least one other DMARD. Sarilumab is an injectable drug that blocks the effects of interleukin-6 (IL-6) by binding the IL-6 receptor. It’s also called an IL-6 (receptor) inhibitor. It can be used either alone or in combination with methotrexate or other DMARDs. Sarilumab (Kevzara®) targets the immune system’s production of IL-6, which can cause inflammation. Some people with RA may make too much IL-6, so this drug may help them get their inflammation under control and lower their disease activity. Like other biologic DMARDs approved to treat RA, it may help control symptoms like pain and joint swelling.
The typical dose of sarilumab (Kevzara®) is 200 mg taken every two weeks. It’s an injectable drug that comes in prefilled syringes. People who need to manage neutropenia (low white blood cell count), thrombocytopenia (not enough platelets in the blood that aid clotting) or elevated liver enzymes may lower their dose to 150 mg injected every two weeks.
You give yourself injections of sarilumab (Kevzara®) at home. It’s a subcutaneous injection, which means that the shot goes into the skin or flesh, not into a muscle. If you’re not used to giving yourself injections or feel a little uncertain about how to do it properly, ask the nurse at your rheumatologist’s office to show you how.
Like many other DMARDs, sarilumab (Kevzara®) lowers your immune system defenses. You may have less ability to fight off infections. There’s also a risk of getting serious infections like tuberculosis (TB), or other bacterial, viral, and fungal infections. Your rheumatologist will test you for TB infection before you start using sarilumab (Kevzara®) (if you have not had been tested in the last six to 12 months), and monitor you during treatment to look for any warning signs of TB. If you notice any signs of a possible infection, like fever, chills, cough, body aches, unexpected weight loss, diarrhea, a burning feeling when you urinate, or red or painful sores on your skin, let your rheumatologist know right away.
Side Effects of Sarilumab (Kevzara®)
The most common side effects of sarilumab (Kevzara®) are upper respiratory tract infections, which could have symptoms such as a runny nose, sore throat, or nasal congestion. Urinary tract infections are also possible. Some people may have redness around the site where the injection goes into the skin.
Ustekinumab (Stelara®) is indicated for adults with plaque psoriasis, psoriatic arthritis, and Crohn’s disease, and adolescents with plaque psoriasis.
It’s a biologic that blocks two cytokines, interleukin 12 and interleukin 23 (IL-12/23). Ustekinumab (Stelara) targets interleukins 12 and 23 because they play a role in psoriatic inflammation. This drug blocks those two cytokines and helps ease your inflammation and symptoms like joint pain or swelling. It can also ease plaque psoriasis symptoms.
You may take it either alone or with methotrexate. You may either give yourself injections of ustekinemab (Stelara) or your healthcare provider, such as your doctor or nurse, can inject you at the doctor’s of office. You will start ustekinumab (Stelara) with a 45 mg dose and then another 45 mg dose four weeks later. After that, you will get 45 mg shots every 12 weeks. If you weigh more than 100 kg, your dose will be 90 mg.
Side Effects of Ustekinumab (Stelara®)
In people with psoriatic arthritis, the most common side effects of ustekinumab (Stelara) are joint pain, arthralgia or muscle aches, nausea, and dental infections.
Ustekinumab (Stelara) can lower your body’s ability to fight infections. If you notice signs of an infection, such as fever or chills, let your doctor know right away. Your doctor will give you a tuberculosis (TB) test before you start this or any other biologic drug.
This drug can also increase your risk of certain cancers, so let your doctor know if you have had cancer in the past or if you have a family history of cancer. Some people who were at higher risk for skin cancer did develop certain skin cancers while they took this drug. If you notice any unusual or new moles or skin growths, tell your doctor right away.
One possible risk of ustekinumab (Stelara) is a rare condition called reversible posterior leukoencephalopathy syndrome (RPLS). Let your doctor know if you notice any signs of this condition: headaches, seizures, confusion, or vision problems. If caught and treated early, RPLS is treatable.
Like all drugs, it is possible to have an allergic reaction to ustekinumab (Stelara). If you feel faint, notice a rash, or have sudden swelling of your eyelids, face, tongue or throat, or feel sudden tightness in your chest, it could be an allergic reaction. Seek medical help right away.
There is not enough evidence on its safety for use during pregnancy. The only limited information on ustekinumab’s use in humans during pregnancy is what are called limited observational studies. These studies are small, and do not use controls to thoroughly evaluate the drug’s effects. You and your rheumatologist can talk about whether or not you should continue to use ustekinumab (Stelara) during your pregnancy if you have active PsA. The drug’s manufacturer has a pregnancy registry to collect more data on its safety.
Secukinumab (Cosentyx) is a biologic used to treat psoriasis, psoriatic arthritis, and ankylosing spondylitis.
Secukinumab works by blocking a cytokine known as IL-17A that can cause inflammation. It is the first and only IL-17A inhibitor approved for adult patients with AS and psoriatic arthritis.
Secukinumab (Cosentyx) is only used by adults, not children. You can take it either alone or with methotrexate. You can give yourself secukinumab (Cosentyx) shots on your own at home. You will use a pre filled, self-injectable device that already contains the right amount of the drug. If you do not want to use a self-injectable device, your healthcare professional can give you your shots at your doctor’s office. Your doctor or nurse can show you how to give yourself injections so you feel confident about doing it on your own.
You may or may not need to start with a loading dose of secukinumab (Cosentyx). This depends on your disease. If your rheumatologist does prescribe a loading dose to start with, you will take 150 mg at weeks 0, 1, 2, 3, and 4, and 150 mg every four weeks afterward. If you do not need to start with a loading dose, you will take 150 mg every four weeks.
Side Effects of Secukinumab (Cosentyx®)
The most common side effects of secukinumab (Cosentyx) are nasopharyngitis, upper respiratory tract infection, headache, nausea, and hypercholesterolemia.
Secukinumab (Cosentyx) can lower your body’s ability to fight infections. If you notice signs of an infection, such as fever or chills, let your doctor know right away. Your doctor will give you a tuberculosis (TB) test before you start this or any other biologic drug. Do not get any live vaccines (such as the u vaccine) while you take secukinumab (Cosentyx).
Like all drugs, it is possible to have an allergic reaction secukinumab (Cosentyx). If you feel faint, notice a rash, or have sudden swelling of your eyelids, face, tongue or throat, or feel sudden tightness in your chest, it could be an allergic reaction. Seek medical help right away.
There are no adequate, well-controlled studies on the safety of secukinumab’s use during pregnancy.
Abatacept (Orencia®) is a prescription biologic medicine used for psoriatic arthritis and rheumatoid arthritis.
Abatacept works by blocking signaling to a special kind of white blood cell called a T cell. It is available in two forms: a subcutaneous (SC) injection that is a shot that is given just under your skin. It is available as a pre filled syringe or a ClickJect™Autoinjector or as an intravenous (IV) infusion is given by your healthcare provider through a vein in your arm.
T cells play a key role in your immune system, and are probably important players in inflammation. In RA and PsA, your immune system confuses some of your own cells as foreign invaders. Your body activates T cells by mistake to attack what it thinks is an outsider causing disease in your body. Activated T cells send signals to the other inflammatory cells of your immune system. They “wake them” and call them into action. These other inflammatory cells send out signals of their own, and may be linked to inflammation in RA and PsA.
Side Effects of Abatacept (Orencia®)
Common side effects include headache, nasopharynigitis, dizziness and cough.
Abatacept (Orencia®) can make you more likely to get infections or make the infections that you have worse. In some cases, these infections have been fatal.
Like all drugs, it is possible to have an allergic reaction to abatacept (Orencia®) . If you feel faint, notice a rash, or have sudden swelling of your eyelids, face, tongue or throat, or feel sudden tightness in your chest, it could be an allergic reaction. Seek medical help right away.
There isn’t enough evidence to show whether abatacept causes any risks to an unborn baby or the mother during pregnancy.
Tocilizumab (Actemra®) is indicated for rheumatoid arthritis, polyarticular juvenile idiopathic arthritis, and systemic juvenile idiopathic arthritis.
Tocilizumab (Actemra®) works by blocking a cytokine known as Il-6 that can cause inflammation. It can be given by IV infusion or self-injected.
There is very little data on human pregnancies, so it is best to avoid this drug during pregnancy and switch to medications that have been shown to be compatible with pregnancy, like TNF-inhibitors.
Side Effects of Tocilizumab (Actemra®)
Rare reactions include fever and chills and increased risk of infection. Increased cholesterol levels and/or an increase in liver enzymes may also occur. A very rare complication that may occur is bowel perforation, or a hole in the bowel wall. Notify your doctor immediately if you have a history of diverticulitis, develop abdominal pain, or have bloody bowel movements while taking tocilizumab (Actemra®).
Actemra® Copay Card Program
Actemra®’s manufacturer, Genentech, offers a copay card program that can help eligible patients save on their out-of-pocket costs. Learn more about Actemra®’s copay card program.
Rituximab (Rituxan®) is used to treat rheumatoid arthritis.
It works by blocking a special kind of white blood cell known as B cells. Rituximab is given by IV infusion.
Side Effects of Rituximab (Rituxan®)
Some patients can feel side effects during or up to 24 hours after receiving rituximab (Rituxan®). They can include mild throat tightening, flu-like symptoms, rash, itchiness, dizziness, and back pain. In rare cases, patients may experience wheezing, mouth or throat swelling, trouble breathing, or chest pain.
Other side effects may include headache, cough, nausea, upset stomach, sweating, nervousness, muscle stiffness, and numbness. In very rare cases, a severe skin reaction, mouth sores, vision changes, loss of balance, difficulty walking, or confusion may occur.
Contact your doctor immediately if you experience these. Some side effects can be reduced by taking a steroid injection before your rituximab (Rituxan®) infusion, or by taking acetaminophen (Tylenol®) or diphenhydramine (Benadryl®). Sometimes an infusion may be stopped and then restarted at a slower rate to ease the frequency of side effects.
There is a lack of evidence to show that rituximab is safe to use during pregnancy, and some evidence shows that it may increase the risk of lymphocytopenia in fetuses. It isn’t the right choice for most women in pregnancy, but can be used in rare cases under the direction of a rheumatologist.