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Biological medications: The basics

Created date

May 24th, 2017
Photo a dropper with a drop of liquid above a row of test tubes

Surveys show that Medicare beneficiaries fill anywhere from 20 to 60 prescriptions each year. That’s a lot of medicine. But very few of those prescriptions are for biological medications, commonly called biologics.

Biologics are not typical drugs. According to the Food and Drug Administration, biologics include vaccines, blood and blood components, cells, tissues, gene therapy, and proteins. The drugs themselves can be isolated from natural sources and are produced by complicated biotechnology. 

Most people are familiar with some biologics, including insulin and vaccines. Newer biologics, however, are a triumph of modern medical science. They are different from most other medicines for a few reasons. According to the Biotechnology Innovation Organization, the ingredients in conventional medicines are all known chemicals, and they are assembled in an ordered fashion. Biologics, on the other hand, are complex proteins manufactured from living organisms, not chemicals. Scientists manipulate the genetic makeup of these organisms so they will produce the active compounds needed to fight a disease. 

How they work

“Biologics can be used for conditions such as rheumatoid arthritis, psoriatic arthritis, psoriasis, inflammatory bowel disease, Crohn’s disease, and multiple sclerosis,” says Vrinda Suneja, M.D., medical director at Fox Run, an Erickson Living community in Novi, Mich.  “With these diseases, your body’s immune system is overactive, and the medicine works by decreasing the immune response. They do not cure the disease, but they may slow the progression and make symptoms more manageable.”

Some biologics are used to treat certain types of cancer. “Biologics for cancer work by stimulating your immune system to fight the cancer cells,” Suneja explains. 

Researchers have been on the fast track finding more uses for biologics. According to the Pharmaceutical Research and Manufacturers of America, biologics are in development for over a hundred diseases, including type 2 diabetes and cardiovascular diseases.

Expensive treatment

These treatments are costly—as high as $50,000 for a year’s worth of medications in some instances. Medicare and most insurances cover them, but depending on your copayments, coinsurance, or deductibles, you could still pay a significant portion. Some pharmaceutical companies offer discounts or other financial assistance. Don’t look for generic versions of these drugs any time soon—the development process is difficult to replicate.

Currently, almost all biologics are in injectable form. The dosing schedule is typically weekly, monthly, or a few times a year. Depending on the drug, they can be administered intravenously in an outpatient setting or self-administered (like an insulin shot) at home.

Self-care on biologics

People on biologics need to be diligent about caring for themselves. “Because biologics affect your immune system, you are more susceptible to contracting infections,” says Nathan Wei, M.D., a board-certified rheumatologist at the Arthritis Treatment Center in Frederick, Md. 

“Frequent and thorough handwashing is one of your best defenses,” Suneja says. “If you know someone who has a cold, flu, or any other type of infectious illness, try to limit your contact with them.”

Staying safe also means keeping your vaccines up to date, but it can be a little tricky balancing your regular vaccines with your biologic therapy schedule. “Patients who receive a shingles vaccine or other live vaccines should wait before starting biologic therapy,” Wei says. “In addition, there are certain timeframes around which vaccines against pneumonia and influenza might necessitate a delay of biologic therapy.”

Maintain a running list of your vaccination schedule, and have it with you when discussing biologic therapy with your regular doctor or specialist. 

Side effects of biologics depend on the type of therapy. Common examples include muscle aches, weakness, fatigue, nausea, vomiting, diarrhea, and appetite loss. “Report all side effects to your doctor—especially a fever or chills,” Suneja says. “Even if a symptom seems minor to you, it could be a sign of infection and needs to be treated immediately.”



Examples of common biologics and what they treat*

Humira (adalimumab): rheumatoid or psoriatic arthritis, plaque psoriasis, Crohn’s disease, ulcerative colitis, ankylosing spondylitis

Remicade (infliximab): same diseases as Humira

Enbrel (etanercept): plaque psoriasis, psoriatic arthritis, rheumatoid arthritis

Avonex (interferon beta-1a): multiple sclerosis

Neupogen (filgrastim): neutropenia (low white blood cell count) due to cancer chemotherapy

Herceptin (trastuzumab): breast cancer, gastric cancer

Avastin (bevacizumab): metastatic colorectal cancer, nonsmall cell lung cancer, glioblastoma, metastatic kidney cancer

Rituxan (rituximab): Non-Hodgkin’s lymphoma, chronic lymphocytic leukemia, rheumatoid arthritis

*Biologics are designed for very specific forms of the diseases listed above. Your doctor can determine if you are a candidate for biologics.