Discuss The Risks With Your Doctor
Make sure you understand the potential risks of biologic agents before adding them to your treatment plan. Your doctor may suggest you take certain precautions before you begin taking these drugs. For instance, because vaccines that contain live viruses are risky for people with altered immune systems, you might get shots for diseases such as before taking a biologic agent.
After you begin taking biologic agents, you should report fevers, , or other signs of infection to your rheumatologist. He or she will probably tell you to stop taking the drug until your infection is cured, Dr. ODell says.
In addition, call your doctor immediately if you experience any of these side effects:
-
Changes to your skin, including , , rashes, red patches, or pus-filled bumps
Immunomodulatory Effects Of Btk Inhibitors
Beyond its role in the development and functioning of B cells, BTK seems also to play a key role in innate immunity, being expressed in myeloid and other innate immune cells and regulating a number of immunological signaling networks within cells of the innate immune system . Moreover, as mentioned above, the selectivity for BTK of ibrutinib in particular is far from being absolute, which can result in off-target effects on immune cells of both the innate and the adaptive immune system. Therefore, the immunomodulatory effects of BTKis can depend both on on-target on immune cells other than B cells and off-target effects.
How Common Are Side Effects
The chances of side effects depend on the type of biologic drug you use, how long you use it, your medical history, and how your body responds to the drug.
One study looked at 1,000 people who took a biologic medication and 1,000 who got a placebo. In the biologic group, 770 reported a side effect — slightly more than the 724 who reported side effects in the placebo group.
The researchers also found that 127 of 1,000 people who received a biologic reported a serious side effect, compared with 118 of 1,000 who took a placebo.
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Side Effects Of Biologic Drugs
The side effects of biologics usually depend on the type of medicine you use.
Common side effects of biologic drugs include:
Injection or infusion reactions. You may have a skin reaction where the shot went in, especially when youâre just starting treatment. This might include:
- Redness
These things should go away on their own. Tell your doctor if they get worse or last longer than 5 days.
Some people who get infusions of biologic medicines have a reaction that can be mild or serious.
Symptoms of a mild reaction can include:
- Pain
- Swelling of the face and hands
Nausea. Biologic drugs can upset your stomach.
Headaches. Headaches are more common in people who use biologic drugs.
Infection. Biologic meds raise your risk of infection because they weaken your immune system. You could get a cold, a sinus infection, an upper respiratory tract infection, bronchitis, or a urinary tract infection . One study found that people who take these drugs may also be more likely to test positive for COVID-19.
Reactivation of infections. A biologic medicine can cause the return of conditions like hepatitis B or tuberculosis if youâve had them before. Your doctor will test you for these infections before you start treatment.
Fatigue. For most people, biologics help treat the fatigue that often comes with an autoimmune condition. But in some, the tiredness may get worse or even last after you stop taking the drug.
The Side Effects Sound Scary Which Ones Do I Need To Worry About Most
The most common misconception or concern I hear in my practice is that taking biologics will wipe out someones immune system, leading to infections, health problems and risk of death. When you take a drug that affects your immune system, you do have to keep an eye out for cancer and infections. So, before you start a biologic, you will be screened for cancer as appropriate for your age and sex, and for infections like tuberculosis and hepatitis. We also recommend everyone on these drugs gets the appropriate immunizations for their age, like flu and pneumonia shots, to reduce infection risk. But people live better and longer with these drugs than without. Major risks are associated far more with the disease and the consequences of untreated disease than these drugs. Biologics reduce the risks of premature death, increased heart disease and the need for joint surgery. Patients with uncontrolled RA are also at higher risk of infection, so controlling the arthritis can also reduce overall infection risk. On balance, you are much better off with treated disease than untreated.
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What Is A Biologic
Biologics are medications that can be used to treat certain types of arthritis. They are a type of medication called a disease-modifying anti-rheumatic drug or DMARD for short which may prevent the development of joint damage. DMARDs, including biologics, are different to medicines that simply block the pain or other symptoms youre feeling. They work by blocking specific substances in the immune system.
Usually the immune system fights infections to keep you healthy. In autoimmune diseases such as rheumatoid arthritis, the immune system mistakenly takes aim at itself, attacking its own healthy tissues. This leads to very high levels of certain natural substances, called cytokines, in the body that then cause joint inflammation and pain. Biologics are very effective at blocking these substances. This dampens down the immune system, and reduces inflammation, pain and damage to the joint. ; ; ;
Biologics mimic substances naturally produced by the body. They are made from living cells, which is the key difference from most other medicines that are made from man-made or chemical compounds. They can be very effective in treating inflammatory arthritis and tend to work more quickly than conventional DMARDs . There are a number of biologics that target different parts of the immune system. If your arthritis does not respond to one type of biologic, your rheumatologist may use a different biologic to see if it works better for you.
Morbidity And Mortality Threat From Comorbidity Less Asthma Itself
Dr. Juhn points out that major morbidity and mortality from poorly controlled asthma has declined and respiratory outcomes have improved due to evidence-based guidelines and advanced therapy. However, he says, threats to the health of people with asthma due to asthma-associated comorbidity, especially serious and common nonrespiratory conditions, are largely unrecognized by patients and their caregivers, clinicians and researchers.
If we know why some people with asthma are healthy, why others develop serious asthma-associated comorbidity and who is susceptible to asthma-associated comorbidity, we might be able to mitigate the risk and outcomes of asthma-associated comorbidity, he says. These are our central research questions to be addressed in the lab.
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When Are Biologics Used As A Treatment For Arthritis
Biologics can be used to treat rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. They can also be used for juvenile idiopathic arthritis, a type of arthritis that affects children.
Biologics are not routinely prescribed for all people with inflammatory arthritis. They can only be prescribed by a specialist, such as a rheumatologist, and under strict criteria. They are usually only given to people whose arthritis has not responded to conventional DMARDs or who have had side effects from them. The decision to prescribe biologics is not made lightly and it is normal to need time to consider the pros and cons of using this type of medication. Work with your rheumatologist and rheumatology nurse to understand why biologics have been recommended and communicate any concerns or fears you might have so that they can support you to make the best decision.
What Are The Risks Of Biosimilars
The risks and side effects of biosimilars are the same as those associated with their biologic reference product. Anyone considering taking a biosimilar should talk with their health care provider about the short- and long-term side effects and risks. It is important to weigh the risks against the benefits.
Biologics and biosimilars act on cytokines, which are specific proteins released by the immune system that can cause inflammation. Biologics suppress the function of the overactive immune system. When on a biologic or biosimilar, you may have a higher risk of infection. If you develop any signs of an infection, contact your health care provider right away.
Signs of infection include:
- Damp, sticky feeling or sweating
- Fever
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What Are The Side Effects Of Biologics
As with any kind of medication, biologics may produce side effects. Since biologics are given as an injection or infusion, its possible to have side effects from the actual infusion or injection. There are also some side effects that occur with ongoing use of biologics.
Infusions are done in a clinic setting. Side effects that can occur from the infusion include:
- nausea
- redness or pain at infusion site
- rash
- flushing
Before the infusion starts, you may be given medications to prevent side effects. You will also be monitored throughout the infusion.
Injectable biologics can be used at home. You may give your own injection or have someone help you do it.
Side effects of the injection can include:
- pain or itchiness at the injection site
- redness or a rash in the area around the injection site
Beyond those that may occur at the time of the injection or infusion, other side effects are possible.
The most common side effects of either injected or infused biologics are:
- fatigue
How Do Biologics For Ra Work
Biologics work by interrupting immune system signals involved in the inflammatory process that result in damage to joint tissue.
The first type of biologic approved for use in treating RA was designed to target the protein called TNF. These drugs are called anti-TNF biologics, and they block specific steps in the inflammatory process.
While they dont suppress the immune system broadly like conventional DMARDs, they do affect immune system function.
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Biologics Have Various Potential Side Effects
Because biologics target only parts of your immune system, as opposed to your entire immune system, you may have fewer side effects than you would with oral immunosuppressive medications or drugs. With that said, every medication has a potential for side effects, and biologics are no different. The side effects can and do vary from drug to drug. Drug labels can be a little overwhelming to read when youre starting a new medication, so dont be afraid to ask your doctor about side effects. Your clinician wont always know how a specific medication may affect you, but you can ask about common side effects experienced by their other patients.
Reactions at the infusion or injection site are generally the most common biologic side effects. You might notice some redness, pain, swelling, or even some itching at the spot on your skin where the needle went in. This kind of reaction is typically mild and benign, according to Maximilian F. Konig, M.D., rheumatologist and instructor in the division of rheumatology with the Johns Hopkins University School of Medicine.
Additionally, you may be more vulnerable to infections because biologics suppress your immune system. If your doctor doesnt bring this up, then you may want to ask whether its helpful to take any particular precautions to reduce your risk of getting contagious illnesses.
Biologics Are Injected And Infused
Its important to know that biologics are administered by infusion or subcutaneous injection, so they can be a little more involved than just taking a pill.
With infusions, youll need to visit a hospital or clinic for your treatment. The process can take a couple of hours, and you can listen to a podcast, read a book, scroll through emails on your phone, or just rest during this time. Some patients find it relaxing, Alexander Geevarghese, D.O., rheumatologist at Northwestern Medicine Central DuPage Hospital, tells SELF. Some hospitals or health-care organizations also offer home infusion programs, in which a nurse comes to your house and administers the medication to you. If you have a very inconsistent schedule or you travel a lot, consider talking to your doctor about whether infusions are right for you. The frequency of infusions varies depending on your specific medication, and your doctor can help you find something that fits your lifestyle.
Injectable biologics are self-administered at home, so they require you to be more hands-on unless you have a family member, roommate, or friend give you the injection. Otherwise, you can self-administer the medication, which many people store in their refrigerators since it must stay chilled. One benefit of using injectables is that you can take the medication with you on trips, as long as you store it in a cooler or use ice packs to keep it cold.
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The Importance Of Staying On Your Medication If You Are Healthy
Although you might assume that medications that modify your immune system could make you more susceptible to infections like coronavirus or complications from it, many questions remain about their impact on COVID-19 specifically. There is not yet definitive evidence whether certain medications could cause worse outcomes for patients, or, on the flip side, even possibly be protective against COVID-19 complications.
In fact, a;recent case series published in the;New England Journal of Medicine;found that baseline use of biologics is not associated with worse COVID-19 findings.;Read more here about the preliminary research.
What is known: When inflammatory arthritis is not well-controlled your immune system tends to focus on attacking your own body rather than outside threats .
Arthritis that is flaring means that your immune system may be less able to fight off infection.
Doctors are urging patients to stay on their medications and maintain good control over their inflammatory conditions to avoid disease flares. Stopping medications without consulting your doctor could mean more flares, pain, and potentially other organ manifestations, such as lungs, kidneys, skin, eyes, says;Brett Smith, DO, a rheumatologist with Blount Memorial Physicians Group in Alcoa, Tennessee.
- Hydroxychloroquine or chloroquine
- Sulfasalazine , methotrexate , leflunomide
- Immunosuppressants
- Biologics
- Corticosteroids
How Are Biologics Given
Most biologics are given as either an infusion or an injection via a needle. ; Infusions are usually given by a nurse at a hospital or clinic, or sometimes at home. Injections are given via a needle, usually into the stomach area or thigh. Your rheumatologist, rheumatology nurse or pharmacist will usually teach you how to safely do the injection yourself, or teach a trusted friend or family member to do it for you. Alternatively, your GP or their nurse may be able to do the injections for you.
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Mayo Research Examines How Asthma Affects Immune System Increasing Risk For Nonrespiratory Conditions
Young Juhn, M.D. , focuses his research on determining how asthma affects the immune system specifically, the extent to which asthma epidemiology affects the risk and severity of communicable and noncommunicable diseases.;Asthma patients have a much higher risk of asthma-associated comorbidity including pneumococcal diseases, otitis media, community-acquired pneumonia, Streptococcus pyogenes upper respiratory infections, influenza, breakthrough chickenpox and pertussis, according to Dr. Juhns research.
This makes sense because these conditions are all airway infections, and asthma has an altered airway architecture including epithelial innate immune dysfunctions, says Dr. Juhn, director of the Asthma Epidemiology Research Unit at Mayo Clinic and a consultant in the Department of Pediatric and Adolescent Medicine. But we wanted to learn whether asthma patients susceptibility also applied to nonrespiratory conditions including systemic inflammatory and autoimmune diseases.
Side Effects Of Biologics For Ra
Biologics work in treating RA for more people because they target specific parts of the immune system to reduce inflammation in the joints.
This means they can have fewer side effects than other types of drugs. But any drug that suppresses the immune system carries risks.
Side effects can include:
- severe infections, such as lung infections
- liver damage
- reduced ability to make new blood cells
- nausea
- pain or swelling at the injection site
- potentially increased risk of certain types of cancers
Some medications used to treat RA that affect the immune system do have the potential to increase cancer risk, particularly lymphomas.
In people living with autoimmune arthritis, the severity of the inflammation has been associated with increased risk for lymphoma in the past.
More recent research has suggested that these medications may not increase cancer risk, so more research is needed. For many living with other risks, the benefits of managing RA outweigh any higher risks of cancer.
Tell your doctor about any unusual symptoms you have, which can include a fever or other symptoms that you cant explain.
For instance, biologics can cause a dormant infection to become active again. For this reason, you should have a tuberculosis test and hepatitis screening before taking one of these drugs.
People with liver disease may not be able to take a biologic drug. If you have liver issues, ask your doctor if biologics are safe for you.
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Is More Exercise Betteror Can Too Much Hurt Your Immune System
If a moderate amount of exercise can stimulate your immune system, will longer or more vigorous exercise have a greater effect? Or can it actually weaken your immune system?
Thats a question thats been hotly debated for years, and as with many questions in the field of science, there isnt exactly a consensus on the answer. According to Nieman, vigorous exercise of a long durationthink 90 minutes or more, like youre racing a half marathon or a marathonstarts to over-stress your immune system, which can temporarily impair its ability to do its job and leave you more vulnerable to infection during this time. Thats whats known as the open window hypothesis.
Now, evidence does show that some elite athletes get sick with upper respiratory infections after competition, but Turner and other experts argue that its not exactly the exercise thats to blame: It is misleading to conclude from existing evidence that exercise is the causative factor of URI among athletes, Turners team wrote in a new debate paper on exercise and immune suppression published in Exercise and Immunology Review this year. After all, Turner tells SELF, even though some immune cell counts are lower after intense exercise, it isnt because theyve died offtheyve just gone off to other tissues in the body to continue their infection patrol.