Top 10 Biologic Medications in the United States

Biologics are drugs made from complex molecules manufactured using living microorganisms, plant, or animal cells. Many are produced using advanced biotechnology techniques. Biologics are sometimes referred to as biopharmaceuticals, or biological drugs, and are administered under close medical supervision.

Biologics target different pathways in the immune system to treat disease. Biologics can reduce inflammation and stop joint damage common in psoriatic arthritis, improving quality of life. Rheumatoid arthritis, certain cancers, and diabetes have the greatest number of dedicated biologic treatments.

How Biologics Work

Biologic drugs target specific proteins or cells in your body. They also target pathways of the immune system that trigger inflammation.

For example, those designed to treat rheumatoid arthritis block certain inflammatory proteins or pro-inflammatory cells. Biologic cancer treatments help the body's immune system identify and destroy cancer cells.

Examples of different types of biologics include:

• Vaccines
• Insulin
• Cancer therapies
• Some gene therapies
• Growth factors
• Monoclonal antibodies

Biologics don't always work for everyone, and it can be challenging to find the right biologic medication. They can also have severe, sometimes life-threatening side effects.

Side Effects

There are a range of potential side effects from the administration of biologics. The severity depends on the type of biologic, duration of use, a person's medical history, and how a person's body responds to the drug. Consult your healthcare provider before beginning use.

For example, with rheumatoid arthritis biologics, there may be mild pain, redness, and swelling at the injection site. More adverse side effects can include serious infections including tuberculosis, bacterial sepsis, and invasive fungal infections.

Some common side effects of biologics may include:

• Fatigue
• Headaches
• Infections
• Nausea
• Pain, swelling, itching, or rash at the injection site
• Fever/chills
• Respiratory (difficulty breathing)

Some severe side effects may include:

• Heart problems (chest pain, heart attack)
• Severe allergic reaction (anaphylaxis)
• Bleeding
• Kidney/liver problems
• Mental health problems (depression, hallucinations)

Potential Risks

Some potential risks associated with these biologics may include:

• An increased risk of developing certain cancers such as lymphoma and basal or squamous cell skin cancers
• Severe allergic reaction (anaphylaxis)
• Increased risk of serious infections (tuberculosis, fungal, bacterial, or viral infections)
• Increased risk of reactivation of viruses, like hepatitis B
• Kidney injury
• Hemorrhage
• Gastrointestinal perforations
• Hypoglycemia (low blood sugar)
• Detached retina
• Blood clots

Some biologics, like Humira and Herceptin, have a boxed warning, the strongest warning issued by the FDA. This indicates the drug carries a significant risk of serious or even life-threatening adverse effects. Consult with your healthcare provider before you start treatment and understand the risks.

Examples of Biologics

There are various types of biologics for different conditions, including rheumatoid arthritis, cancer, and diabetes. This list includes the top 10 biologics in the United States and what they are approved for.

Humira (adalimumab)

• Rheumatoid arthritis
• Plaque psoriasis
• Crohn's disease
• Ulcerative colitis
• Ankylosing spondylitis
• Psoriatic arthritis
• Polyarticular juvenile idiopathic arthritis
• Hidradenitis suppurativa
• Uveitis
  

Enbrel (etanercept)

• Rheumatoid arthritis
• Plaque psoriasis
• Psoriatic arthritis
• Polyarticular juvenile idiopathic arthritis

Remicade (infliximab)

• Rheumatoid arthritis
• Crohn's disease
• Ankylosing spondylitis
• Psoriatic arthritis
• Plaque psoriasis
• Ulcerative colitis

Avastin (bevacizumab):

• Cervical cancer
• Hepatocellular cancer
• Metastatic colorectal cancer 
• Metastatic renal cell carcinoma
• Epithelial ovarian, fallopian tube, or peritoneal cancer
• Glioblastoma
• Non-squamous non−small cell lung cancer 

Herceptin (trastuzumab):

• HER2+ breast cancer
• HER2+ metastatic gastric or gastroesophageal junction adenocarcinoma

Rituxan (rituximab)

• Non-Hodgkin's lymphoma
• Chronic lymphocytic leukemia
• Rheumatoid arthritis
• Granulomatosis with polyangiitis
• Pemphigus vulgaris

Lantus (insulin glargine):

• Diabetes

Avonex (interferon beta-1α):

• Multiple sclerosis (MS)

Lucentis (ranibizumab):

• Age-related macular degeneration
• Macular edema following retinal vein occlusion
• Diabetic macular edema
• Diabetic retinopathy
• Myopic choroidal neovascularization

Neulasta (pegfilgrastim):

• Neutropenia related to cancer chemotherapy
• Hematopoietic subsyndrome of acute radiation

Summary

Biologic medications are complex drugs manufactured from living cells. They work by targeting specific proteins or cells in the body. 

Biologics are used to treat conditions such as immune diseases, cancer, and diabetes. They may not work for everyone, and they can have serious side effects. Be sure to discuss these medications with your healthcare provider before using them.