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What are biologic DMARDs?

Biologic disease-modifying antirheumatic drugs (DMARDs), also known as biologic agents, biologic response modifiers, or biologics, work by targeting a particular protein that contributes to rheumatoid arthritis (RA). Currently,   four types of biologics are approved to treat RA and are named for the inflammatory proteins they target:
  • TNF-blockers (also called inhibitors) -- adalimumab (Humira),   certolizumab pegol (Cimzia), etanercept (Enbrel), and infliximab   (Remicade)
  • T-cell costimulator -- abatacept (Orencia)
  • B-cell inhibitor -- rituximab (Rituxan)
  • Interleukin-1 inhibitor -- anakinra (Kineret)
Biologic DMARDs may be used on their own or in combination with other treatments, including chemical DMARDs. The most common second step in rheumatoid arthritis therapy -- after methotrexate alone -- is combination therapy with   methotrexate and a TNF-blocker. Other biologics may be used if TNF-blockers have not been effective, are not well tolerated, or are contraindicated.
A common but short-term side effect of all biologics is a skin reaction at   the injection site. And all biologics increase the risk of infection, although to different degrees. TNF-blockers have been linked to serious fungal infections, tuberculosis (TB), and some cases of nerve damage; infliximab may cause severe allergic reactions; and rituximab has been linked to a rare but life-threatening brain infection. 

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