With nine biologic medications available to treat rheumatoid arthritis, it can be difficult knowing which to choose and how they compare. Read my previous post - Biologic Medications for RA: The Big Picture - for a run-down of medications including Actemra, Cimzia, Simponi, Rituxan, Orencia, Humira, Kineret, Remicade and Enbrel.
Today, we’re comparing Actemra, Rituxan and Orencia which are medications FDA-approved for the treatment of moderate-to-severe rheumatoid arthritis.
The Immune System in RA
The exact cause of rheumatoid arthritis is unknown. However, RA is most likely triggered by a combination of factors, one of which being an abnormal autoimmune response. Involved in the inflammation associated with rheumatoid arthritis are B-cells and T-cells, which belong to a class of white blood cells called lymphocytes.
If the T-cell recognizes an antigen as "non-self," it will produce cytokines (such as TNF-alpha, IL-1, or IL-6) which cause B-cells to multiply and release immune proteins (antibodies). These antibodies circulate in the bloodstream, recognizing the foreign particles and triggering inflammation to rid the body of the invasion. For reasons that are still not completely understood, both the T-cells and the B-cells become overactive in patients with RA.
What do these drugs do?
Each of these drugs interfere with the communication between cells which cause excess inflammation associated with rheumatoid arthritis. ACTEMRA (tocilizumab) is an interleukin-6 (IL-6) receptor inhibitor. ORENCIA (abatacept) is a selective costimulation modulator with inhibits T-cell activity. RITUXAN (rituximab) is a monoclonal antibody therapy which binds to CD20+ B-cells and causes their destruction.
ACTEMRA, RITUXAN and ORENCIA are intended for patients who have had inadequate response from at least one TNF-inhibitor medication (such as Cimzia, Simponi, Humira, Remicade and Enbrel). Read RA Biologics: Cimzia vs. Simponi for more information.
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