What Are Biologic Response Modifiers?

Think back to high school chemistry classes.  I remember making peanut brittle to learn about double-bonds, making ice cream to drive home the point that salt affects the freezing point, making yellow paint then pouring it down the drain and having to promise not to do that one at home since lead in paint had been banned, popping corn in a beaker during the instructor’s lecture (oh, wait, that last one wasn’t an approved activity).  I remember having multiple beakers of a substance, then adding a different chemical to each one just to see what would happen.  The investigations in chemistry lab were fascinating. 

Now there are people taking it to a whole new level.  Imagine learning the specific function of different kinds of cells, then figuring out how to influence those cell proteins.  What a cool job! 

Some researchers look at what takes place in a cell during inflammation.  There are a bunch of different proteins involved, and sometimes attacking one of those proteins makes a difference.  It reminds me of that row of beakers back in high school, dropping different chemicals in to see what would happen.  It is incredible that scientists can modify the way our cells respond (biologically) to inflammation.

Biologic response modifiers (BRMs) are a class of disease modifying anti-rheumatic drug (DMARD) that targets specific cells.  When these drugs work, the inflammation of RA is greatly reduced – which means a reduction in pain and fatigue, and less likelihood of joint damage.  I discussed them a little with my PCP the other day (more on that in a future post).

Here, then is a list of the biologic response modifiers currently available. 

Tumor Necrosis Factor Alpha Inhibitors (aka TNF-α blockers) 

  • Adalimumab (Humira) – every-other-week injection
  • Etanercept (Enbrel) – weekly injection
  • Infliximab (Remicade) – IV infusion
  • Certolizumab pegol (Cimzia) – monthly injection
  • Golimumab (Simponi) – monthly injection

Selective B-Cell Inhibitors 

  • Rituximab (Rituxan) – IV infusion (two initial doses given two weeks apart, thereafter at 16-24 weeks if needed)
  • Ofatumumab (Arzerra) – IV infusion – still in clinical trials; already approved for leukemia

Selective Costimulation Modulator 

  • Abatacept (Orencia) – IV infusion (three initial doses given two weeks apart, thereafter every four weeks

Interleukin-1 (IL-1) Inhibitor 

  • Anakinra (Kineret) – daily injection

Interleukin-6 (IL-6) Inhibitor 

  • Tocilizumab (Actemra) – injection every 4-6 weeks
    edit to note Actemra was FDA approved 1/8/10 

Two others being studied 

  • Baminercept (BG 9924) – targets lymphotoxin-beta – weekly injection
  • Denosumab (AMG 162) – targets RANK Ligand to reduce bone erosion, does not affect inflammation – twice yearly injections


Yesterday was my last appointment with my PCP for 2009. (I hope; there are still two weeks left in the year, and given the way my luck’s been running, anything might happen.)  I took cookies along – never sure how they’ll be received in December, since everyone bakes Christmas cookies – and the receptionists laughed and explained that they’d just been discussing opening a cookie store because they have so many.  It was nice to have a chance to discuss it, and now I know that a vegetable tray would go over well.

Since I was gone all day, my kids and I cleaned up leftovers for supper.  My husband got home from work late – which usually means he’s tired and not hungry.  Tonight he was famished and there was no meal.  So… (and he doesn’t even read my blog to know about “balanced” meals) he took three pumpkin cookies for a vegetable, a couple lemon/coconut cookies for fruit, two oatmeal scotchies for a grain serving, a tall glass of eggnog for dairy/protein, and a couple chocolate chip cookies for dessert.

Here are the recipes for my favorite cookies:

Lemon Filled Molasses Bars



1 pound butter
4 C sugar
4 eggs


1 C molasses


9 cups flour
4 tsp cinnamon
2 tsp baking soda
1 tsp salt

Mix well.  Cover and refrigerate 2-3 hours (or overnight).  While dough chills, make and chill filling (below).

Divide dough into four equal(ish) parts.  Divide each of those parts into four (making a total of sixteen chunks of dough).  Roll out each chunk of dough into a rope, and gently press into a flat strip about 3″ wide.  Spread some of the filling on half of the dough, then fold in half and cut into strips.  Filling will not ooze out while cooking.  Bake 350 approx 12 minutes.  Store airtight.


Beat together:

12 eggs
2 C sugar
1-1/2 cups lemon juice
1-1/2 tsp salt

Cook in microwave, stirring occasionally, until thick.  Or you could cook it on the stove top if you like to stand there stirring all the time.  When thick, stir in 4 cups flaked coconut.  Cool. Chill until ready to assemble cookies.  Cooling process can be sped by placing pan of filling in a bowl of ice water.

Pumpkin-Glazed Pumpkin Cookies


Beat together:

1 C butter
3 C brown sugar


4 eggs
2 C cooked, mashed pumpkin
2 tsp vanilla extract


2 Tbsp baking powder
2 tsp salt
2 tsp cinnamon
1 tsp allspice
1/2 tsp ginger
6 C flour

This will make a soft dough.  Drop by rounded teaspoons onto a cookie sheet and bake 375 for 11-13 minutes.  Spoon glaze over warm cookies.  Store airtight.


Stir together:

1/4 C butter
2-1/2 C unsifted powdered sugar (good thing, because there’s no way I could use a sifter!)
2 tsp cinnamon
1/2 tsp allspice

Mix in a heaping 1/3 C mashed pumpkin to make a smooth glaze.

Cardamom Cookies



1 C butter
1/2 C granulated sugar
1/2 C brown sugar


1 egg
1 tsp vanilla
2 C flour
1 tsp fresh-ground cardamom
1/4 tsp salt

Spread dough in 10×15 pan.  Bake at 275 for one hour.  Remove from oven, spread warm cookies with glaze, and cut in bars.


Melt 1-1/2 Tbsp butter.  Beat in 1 C powdered sugar and 1/2 tsp vanilla.  Add water to thin to a drizzling consistency.