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

2 thoughts on “What Are Biologic Response Modifiers?

  1. Another excellent post. Although I’ve been told before, I just haven’t been able to “grok” biologics as DMARDs — until reading this. Yeah, I’m dense sometimes. Anyway, thanks. I love it when you go all teacher on us. :o)

  2. Glad to hear it was useful, Wren. It seemed like something this basic should be all in one place, but I had to search all over and piece the information together. I’m sharing it here in hopes that it might help someone else.

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