ARTHRITIS INFORMATION SHEET

Things to consider when taking a biologic

Biologics are a type of medication that can be prescribed for some forms of inflammatory
arthritis (e.g. rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis).
This sheet gives you general information about how biologics work, why they are used,
as well as tips on the safe use of these medications.
This resource does not provide advice about the specific biologic you may be prescribed
to manage your arthritis. It does not cover all the side effects and safety precautions that
can occur with each biologic. You should discuss this with your doctor, rheumatology
nurse or pharmacist, or see the For more information section at the end of this resource.

What is a biologic? target different parts of the immune system. If your

Biologics are medications that can be used to treat arthritis does not respond to one type of biologic, your
certain types of arthritis. They are a type of medication rheumatologist (arthritis specialist) may use a different
called a disease-modifying anti-rheumatic drug or biologic to see if it works better for you.
DMARD for short which may prevent the development Biologics can also be used in combination with other
of joint damage. DMARDs, including biologics, are DMARDs, particularly methotrexate. The combined
different to medicines that simply block the pain or treatments may be more effective than the individual
other symptoms you’re feeling. They work by blocking medications in some cases. Talk to your rheumatologist
specific substances in the immune system. or rheumatology nurse to better understand the pros
Usually the immune system fights infections to keep you and cons of using a combination of a biologic and a
healthy. In autoimmune diseases such as rheumatoid DMARD.
arthritis, the immune system mistakenly takes aim at Biologics can also be used to treat other autoimmune
itself, attacking its own healthy tissues. This leads to very diseases, such as Crohn’s disease, kidney disease and
high levels of certain natural substances, called cytokines, inflammatory eye conditions.
in the body that then cause joint inflammation and pain.
Biologics are very effective at blocking these substances. When are biologics used as a treatment for
This dampens down the immune system, and reduces arthritis?
inflammation, pain and damage to the joint. Biologics can be used to treat rheumatoid arthritis,
Biologics mimic substances naturally produced by the psoriatic arthritis and ankylosing spondylitis. They can
body. They are made from living cells, which is the key also be used for juvenile idiopathic arthritis, a type of
difference from most other medicines that are made arthritis that affects children.
from man-made or chemical compounds. They can be Biologics are not routinely prescribed for all people with
very effective in treating inflammatory arthritis and tend inflammatory arthritis. They can only be prescribed by
to work more quickly than conventional DMARDs a specialist, such as a rheumatologist, and under strict
(eg. methotrexate). There are a number of biologics that criteria. They are usually only given to people whose

For your local Arthritis Office:

1800 011 041 www.arthritisaustralia.com.au
 ARTHRITIS INFORMATION SHEET

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.

Types of biologics
There are currently five different types of biologics available. Each targets a different part of the immune system to
help reduce inflammation and joint damage. These are:

Type Name Brand name Biosimilar brand Substance targeted Additional

name information
Tumour necrosis Golimumab Simponi Tumour necrosis factor Often the first type of
factor inhibitors (TNF- Certolizumab Cimzia biologic your doctor
inhibitors) Etanercept Enbrel Brenzys may try.
Adalimumab Humira
Infliximab Remicade Flixceli, Emisima,
Inflectra, Jaximab,
Remsima, Reflexis
Interleukin-6 inhibitor Tocilizumab Actemra Interleukin-6

Interleukin-1 inhibitor Anakinra Kineret Interleukin-1 Not government-

subsidised and is
currently only used in
children with juvenile
idiopathic arthritis.
Targeting Rituximab Mabthera B-cells (a type of white
B-lymphocytes blood cell)
(B-cells)
Targeting Abatacept Orencia T-cells (a type of white
T-lymphocytes (T-cells) blood cell)

Biosimilars as the original biologic. However, as they are not

For some biologics, there may be a biosimilar identical to the original biologic, switching to a
medication available. A biosimilar medicine is a copy of biosimilar may not be the right decision in every case,
a biologic medicine that has been shown to be highly especially if the original biologic is working well for you.
similar to the original medicine. It is important that you and your rheumatologist decide
The nature of biologics means they cannot be together whether you should keep taking the same
copied exactly. Biologic medicines are complex and medication or whether you could consider a biosimilar.
are produced using living cells so there are minor If your rheumatologist wants you to continue with the
differences between brands and batches. This is why original medication, they will tick the non-substitute
competitor brands are called biosimilars as they are box on your prescription. If the pharmacist asks
highly similar but not exactly the same. whether you want to consider a substitution, request the
medication that is on the script and not a substitution.
Biosimilar medicines are comprehensively tested to
Further information about biosimilars is available at
establish that they have similar safety and effectiveness
www.arthritisaustralia.com.au

Your local Arthritis Office has information, education and support for people with arthritis
Infoline 1800 011 041 www.arthritisaustralia.com.au
Disclaimer: This sheet is published by Arthritis Australia for information purposes only and should not be used in place of medical advice.
 ARTHRITIS INFORMATION SHEET

How are biologics given? are recommended. Any live virus vaccine needs to be
Most biologics are given as either an infusion (a drip given one to three months before starting a biologic.
into a vein) or an injection via a needle. Infusions These include:
are usually given by a nurse at a hospital or clinic, - Shingles (herpes zoster) vaccine
or sometimes at home. Injections are given via a
- Measles, mumps and rubella vaccine
needle, usually into the stomach area or thigh. Your
rheumatologist, rheumatology nurse or pharmacist - Oral polio vaccine
will usually teach you how to safely do the injection - BCG vaccine
yourself, or teach a trusted friend or family member to - Some travel vaccines, such as typhoid, small pox
do it for you. Alternatively, your GP or their nurse may and yellow fever vaccines.
be able to do the injections for you.
• Other vaccines. Your doctor will usually recommend
How often do I take the biologic? certain vaccines, such as the flu vaccine, pneumovax
Each biologic has its own schedule or frequency of when and Hep B, before starting treatment.
it is given. Depending on which biologic you are using, • Future surgery. Treatment with a biologic may be
you might need to take it daily, weekly, fortnightly, postponed if you are planning on having surgery.
monthly or only a few times per year. Make sure you • Smoking. It is recommended to stop smoking while
have a clear understanding from your rheumatologist you are taking a biologic.
or rheumatology nurse of how often you need to take
• Latex allergy. Let your doctor know if you have
your medication so there is no risk of missing a dose or
taking too much. As with any medication, it can only an allergy to latex as some of the equipment used
be effective if you take it as directed. to inject certain biologics may contain latex. Most
companies are also releasing latex-free products
TIP: Taking a medication once a week, fortnightly which may be more suitable.
or monthly can be difficult to remember. Write it
in your diary or set an alarm or reminder in your Safety
phone/computer to remind you when to take your Biologics can be positively life-changing medications
next dose. for people with inflammatory arthritis. They are
very effective in dampening the immune system and
Before starting a biologic inflammation. However, the immune system also has
Before a biologic is prescribed, your rheumatologist will an important role in protecting you from infections and
typically talk to you about the following: illness. Your rheumatologist will aim to find the biologic
• Infections. If you have an infection or have a history and the dose that allows you to achieve a balance between
of chronic (long-term) infection, your doctor will the risk of side effects and controlling the arthritis.
not start you with a biologic until the infection has
been treated.
Infections
One of the unwanted effects of using a biologic is an
• History of tuberculosis (TB), hepatitis B or increased risk of infection. You may experience mild
hepatitis C. Biologics can cause certain bacterial or infections, such as colds and sinusitis, more often than
viral infections to reactivate. Your rheumatologist usual. These minor infections may also last longer than
will often recommend tests for TB and hepatitis normal. More importantly, the minor infections can
before starting a biologic. lead to more serious infections such as pneumonia.
• Live virus vaccines. Talk to your doctor about your Your doctor or rheumatology nurse will advise you
immunisation status and whether any vaccinations which symptoms of infection are mild and do not need

For your local Arthritis Office:

1800 011 041 www.arthritisaustralia.com.au
 ARTHRITIS INFORMATION SHEET

medical treatment, and which are more serious and Some types of cancer are more common in people with
require immediate medical attention. They will also severe active inflammatory arthritis, such as lymphoma
tell you who to contact if you are unwell if your GP or (cancer of the lymph glands). However, treatment with
rheumatologist are not available. You can reduce your biologics does not appear to increase this risk further.
risk of getting an infection by avoiding close contact For general cancer prevention, stop smoking, have
with people with active infections and by having the regular skin checks with your GP or a specialist, protect
appropriate vaccinations. your skin from the sun, maintain a healthy body weight,
limit alcohol intake and eat a healthy, balanced diet.
Vaccinations
You should not have any live-virus vaccines if you are Pregnancy and breastfeeding
taking a biologic. These include: Before you try to conceive, it’s important to speak with
• Shingles (herpes zoster) vaccine your rheumatologist about all your arthritis medications,
• MMR (measles, mumps and rubella) vaccine including biologics. Some medications are not
recommended to be used during pregnancy, while others
• OPV (oral polio vaccine)
may be continued throughout or for part of the pregnancy.
• BCG (Bacillus Calmette Guerin) vaccine Some medications can stay in the body for a period of time
• Some travel vaccines, such as typhoid, small pox and after you stop taking them so you may need to stop them a
yellow fever vaccines. few months before you try to conceive. Some medications
Inactivated (dead or killed) vaccines, such as are safe to take while you are breastfeeding while others
pneumovax and the yearly flu vaccination, are safe and should not be used. If you are thinking of becoming
recommended to reduce your risk of those infections. pregnant in the near future or are not using contraception,
Ask your doctor about which vaccinations are you should discuss the most appropriate treatment options
recommended while taking a biologic and always talk with your rheumatologist or rheumatology nurse.
with your doctor before receiving any vaccinations. If you fall pregnant unexpectedly, contact your
rheumatologist immediately for advice.
Cancer risk
The substances blocked by biologics may also play a role Travel
in the body’s defence against cancer. There have been You can still travel domestically and overseas while
concerns that blocking these substances may result in a taking a biologic but plan ahead. Talk to your
higher chance of developing cancer. However, over the rheumatologist to ensure you have an adequate supply
many years of using and studying biologics, there have of your biologic to last your trip, as well as advice on
been isolated reports of cancer but no firm or consistent managing your medications while travelling. Talk to
evidence of a greater risk of cancer than would have your rheumatologist about any vaccinations you may
been expected. need before your trip.

For more information:

The Australian Rheumatology Association has information sheets possible side effects and safe usage of the medication. You will
on each of the biologics. The sheets cover detailed information usually find it in the medication packet or ask your pharmacist.
about how to take the medication, side effects and precautions.
They are available at www.rheumatology.org.au Medicines Line, a telephone service provided by the National
Prescribing Service and healthdirect Australia, gives independent
Consumer Medicine Information is available for each medication information about medicines. Phone 1300 633 424 Monday to
you are prescribed and include detailed information about the Friday 9am to 5pm AEST or visit www.nps.org.au

© Copyright Arthritis Australia December 2017. Source: A full list of the references used to compile this sheet is available from your local Arthritis Office.

Your local Arthritis Office has information, education and support for people with arthritis
Infoline 1800 011 041 www.arthritisaustralia.com.au
Disclaimer: This sheet is published by Arthritis Australia for information purposes only and should not be used in place of medical advice.