Biologics 101: Everything you need to know about autoimmune medications

If you’ve recently been diagnosed with an autoimmune disease, your doctor may have mentioned biologics as a treatment option. Making decisions about starting medications for autoimmunity can be scary and daunting because of the possible side-effects and long-term concerns, and the misinformation promoted by the media.  It’s important that you understand the potential risks and possible benefits that will help you make the best decision for your personal situation. 

 Here’s everything that you need to know about biologic medications so you can make an informed choice.

How do Biologics work?

Biologic medications are a large class of pharmaceuticals that are made from living sources - proteins, cells and tissues - rather than being chemically-derived. For the purposes of this article, I will be referring to biologic medications that are used to treat autoimmune disorders specifically. These biologics are drugs that work to shut down specific parts of the immune system that lead to inflammation. A hyperactive inflammatory cascade can lead to the immune system attacking self-tissues and thus the development of autoimmunity.

What are Biologics used for?

Biologics are commonly used to treat autoimmune diseases with significant symptoms that are not being effectively addressed with other medications like NSAIDs (non-steroidal anti-inflammatory drugs) and DMARDs (disease-modifying anti-rheumatic drugs). 

What are the most common Biologics?

The most common biologics used for autoimmune diseases are Humira (adalimumab), Remicade (infliximab) and Enbrel (etanercept). They’re called anti-TNF drugs because they block the production of a protein called TNF, which is overproduced in many autoimmune diseases and can cause significant systemic inflammation. These biologics are used to treat a wide range of autoimmune diseases including rheumatoid arthritis, psoriatic arthritis, plaque psoriasis, ankylosing spondylitis, Crohn’s disease and ulcerative colitis.

Do I need to be on Biologics for life?

A common question that may be on your mind when making the decision to start a biologic is how long you’re going to need to be on it. For many, the idea of taking a drug that inhibits your immune system for a prolonged period of time raises concerns. Each patient’s autoimmune disease is unique and how one’s body reacts to medications is also unique, making it difficult to create a standardized length of time for biologics to be taken. If you’ve been on a biologic long-term and have not had any symptoms of your autoimmune disease in the past year, you can discuss the possibility of weaning off your biologic with your rheumatologist. Biologics can put your disease into long-term clinical remission but it’s always important to make these decisions with the help of your healthcare provider to avoid re-triggering your autoimmune disease. 

What are the risks of Biologics?

The main risk associated with biologics is serious infections because biologics act to shut down key components of your immune response. This is also why biologics can cause reactivation of diseases like hepatitis B, tuberculosis and herpes infections. Other infections that people on biologics become more predisposed to include pneumonia, skin infections, urinary tract infections and histoplasmosis. Long-term use of biologics can increase risk of developing certain types of cancers like lung cancer, basal cell carcinoma and squamous cell carcinoma, which is also related to the effect of biologics on immune system function. Less common risks of biologics include sudden vision problems, exacerbation of heart failure or sudden onset heart failure, and lupus-like syndrome. Lupus-like syndrome is a cluster of symptoms that resemble lupus, including a rash located on the face and arms that worsens with sun-exposure and joint pain. 

What are the alternatives to Biologics? 

Some rheumatologists may jump straight to prescribing a biologic depending on symptom severity, age, how your disease is affecting your quality of life, and risk factors for other conditions. However, it’s important to note that there are alternative medications to biologics if you are unsure if this is the right choice for you. NSAIDs, otherwise known as non-steroidal anti-inflammatory drugs, are usually the first-line choice for mild-moderate inflammation. Common NSAIDs prescribed include naproxen (Naprosyn), celecoxib (Celebrex) and diclofenac (Voltaren). Disease modifying anti-rheumatic drugs (DMARDs) are another class of medications that are frequently used for various autoimmune conditions, including rheumatoid arthritis, psoriatic arthritis, lupus and ulcerative colitis. DMARDs block inflammation, thereby stopping or slowing the disease process of various types of autoimmunity. In rheumatoid arthritis, DMARDs have been shown to prevent joint damage associated with long-term inflammation. Depending on the severity of symptoms, combinations of various DMARDs can be used for improved efficacy. Common DMARDs include methotrexate, sulfasalazine, and hydroxychloroquine. 

 Depending on the severity of your disease and symptoms, and the concern over negative effects that can be associated with chronic or high-dose use of any of these pharmaceutical options,, certain nutraceuticals and herbal medicine formulations may be used as an alternative to medications, or as adjunctive treatment. Common anti-inflammatory herbs include boswellia, curcumin, white willow bark and devil’s claw. When used in combination, these herbs can provide significant pain relief and reduce inflammation. In autoimmune conditions, the systemic inflammation present can create a state of oxidative stress in which there are excess reactive oxygen species (ROS), which can damage tissues and organs. Antioxidants such as glutathione, vitamins C and E, flavonoids, resveratrol and CoQ10 can be helpful nutraceuticals to quench the ROS and thereby reduce the level of oxidative stress that the body is exposed to. 

 Remember, it’s essential to consult your licensed and experienced healthcare practitioner regarding any nutraceutical supplements and/or herbal medicines before you start taking them.  Natural health products must be considered for safety, appropriateness, and quality, as well as interactions with dietary choices and other medications.

 As a naturopathic doctor, my focus is elucidating the root cause of a patient’s autoimmune disease, which may include, but not be limited to; food sensitivities, hormone imbalances, chronic stress, infectious burden or combinations of these. By addressing what originally caused the immune system to go awry, we allow the body to return to a state of health. In some situations, people are able to bring their autoimmune disease into remission with a holistic and integrative naturopathic approach. I like to make the analogy of a sick fish in a fish tank to help people understand the value of root cause medicine: Rather than medicating the fish, the first thing most people would do is change the water and give the fish some nutritious food. Likewise, in treating autoimmune disease, we should be looking at what is going on in the person’s environment that may be making them sick: their food, their stress levels, the toxins and chemicals they’re exposed to, and the infections they’ve experienced in their life. 

I’m passionate about addressing health from a holistic and integrative perspective.  I do the detective work to figure out what is underlying your health concerns, and provide you with the tools and resources you need to thrive.

If you’re struggling with low energy, joint and muscle pains, brain fog, inflammation, have been diagnosed, or suspect autoimmune disease, I’d love the opportunity to work with you.  To get started, click here to book a FREE discovery call.