Treating Rheumatoid Arthritis

“Non-biologic” drugs are a better first choice

Rheumatoid arthritis (RA) is a serious condition. The body’s immune system attacks the lining of the joints. This causes swelling, stiffness, and pain.

RA cannot be cured but it can be treated. Without treatment, RA can cause permanent damage to joints and internal organs, and disability.

How is RA treated?

The main drugs to treat RA are called DMARDS (disease-modifying anti-rheumatic drugs). These drugs help prevent damage to joints. They include both non-biologics and biologics.

Non-biologic RA drugs have been used for a long time.

Biologics are a newer type of RA drug. They are one of the top-selling prescription drugs in the U.S. However, in most cases, biologics should not be the first choice for treatment, according to the American College of Rheumatology. Here’s why:

Non-biologics can be effective, and they cost much less.

Non-biologics are available as generics. Biologics are not, and they cost from $20,000 to $50,000 a year. However, biologics are available as biosimilar drugs, which have slightly reduced cost but are still expensive.

Consider these non-biologics.

Non-biologic RA drugs are better studied than the biologics. Non-biologics include:

  • Methotrexate (Rheumatrex, Trexall, and generic)
  • Leflunomide (Arava and generic)
  • Hydroxychloroquine (Plaquenil and generic)
  • Sulfasalazine (Azulfidine and generic)

Be aware of the side effects with biologics.

The following side effects are rare, but they can be serious or life-threatening:

  • Serious skin or lung infections
  • Skin cancers
  • Serious allergic reactions

Other side effects are less serious: minor infections, headache, and reactions at the injection site. People usually don’t change treatments because of these side effects.

When to take a biologic drug.

Most people should try a non-biologic RA drug for at least three months. If you do not feel better or move more easily after three months, you should talk with your doctor about options such as adding another non-biologic or starting a new biologic. The combination of non-biologics that is sometimes called “triple therapy” may be the most cost-effective.

If a non-biologic or a combination of non-biologics did not help you, there’s a good chance that a biologic will give relief.

People react to drugs differently. If one biologic does not help, you can try another. But never take two biologic drugs at the same time.

In rare cases, your doctor may skip more common treatments and go straight to biologics. This may make sense if your RA is already advanced when it is first diagnosed. Check with your doctor about using this aggressive approach to treatment.

If you need a biologic, ask your doctor if a less expensive version of the biologic, called a biosimilar, is available. Biosimilars are analogous to generic versions of drugs, with similar effectiveness but reduced cost.

This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

© 2018 ABIM Foundation. Developed in cooperation with the American College of Rheumatology.