3 Considerations Before Trying A Biologic For Rheumatoid Arthritis

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Biologic medications are a specific class of disease-modifying anti-rheumatics (DMARDs) that have helped people with rheumatoid arthritis (RA) and other autoimmune diseases. They are often used as monotherapy or in combination with other drugs. If you and your rheumatologist are considering treatment with a biologic, there are factors you need to help you find the right options for your needs and reduce the likelihood of interruptions in your treatment plan.


Biologics can cost several thousand dollars per month of treatment, which can be the deciding factor. Each rheumatologist may approach treatment options differently. For example, some rheumatologists prefer early, aggressive treatment for RA, which often means beginning with a biologic. However, many rheumatologists prefer to start with medications that are less expensive and with the least potential for side effects and work their way toward other treatments. If your rheumatologist prefers to start you with a biologic and cost is a significant factor, you may want to ask for other options first.

Monotherapy with hydroxychloroquine, methotrexate, or sulfasalazine may be a less expensive option to try. If your RA is not well controlled on either drug individually, your doctor might try any of these drugs in combination. Once you have established that a biologic is the next step in your treatment plan, either used alone or in combination with other DMARDs, make sure you  consult available resources to make the costs more affordable. Most drug manufacturers for biologics have patient assistance programs and copayment assistance available.

Route Of Administration

Both cost and your lifestyle can influence which route of administration is best for you. Most biologics are available as intravenous infusions or injectable formulations. Currently, only one is available as a pill. If the biologic you are prescribed is available as an injection, you may need to use the infusion form for a while to ensure you are not having any allergic reactions. The infusions must be performed at an infusion center or other medical setting.

A major inconvenience for some people is the amount of travel it takes to commute back and forth to the infusion center if one is not nearby. Furthermore, infusions may take several hours to complete, in addition to any loading doses of medications you may need, such as pain medications and antihistamines. Depending on the biologic, you may need infusions weekly or every other week, which can be difficult if your schedule is already full.

The injectable form of biologics is often preferred, but it is not without other considerations. Since these medications are considered specialty medications, it is unlikely you can purchase them from your local pharmacy. You must order them and have them shipped to your home or rheumatologist's office. Additionally, these medications require refrigeration, and since they are not shipped by a special courier, there can be problems during the shipping process. If there is any delay in the shipping or if the medication is delivered and left outside, it could be rendered useless. If you choose an injectable biologic, make sure you order refills promptly so if problems occur you can order replacements without delaying your next dose.

Insurance Hurdles

Even if you have decided you are ready to try a biologic, you may face new obstacles if you have insurance. Many rheumatologists have a general idea of which biologic they would like their patient to try first because, based on their experience or how the medication works, it might be more effective at controlling symptoms. Many insurance providers require certain biologic medications to be prescribed first before allowing approval for others.

You may need to try a specific biologic until you have developed a track record of it not working or causing an adverse reaction before you can move on to a different one. Additionally, this may limit your opportunity to select a different route of administration. If you would prefer a biologic in the form of a pill or self-administered injections and your rheumatologist agrees, you may be limited to infusions by your insurance provider.

Many people with RA and other conditions may need treatment with biologics at some point in their treatment. Before starting treatment with a biologic, there are different factors you need to consider to help the process go smoothly, so discuss your options with experienced doctors at a clinic like Arthritis & Rheumatology Associates of South Jersey.