Autoimmune diseases occur when the body’s disease fighting cells get confused and attack itself. The body’s own immune system begins to attack normal tissues cells and organs within the body. Depending on the part of the body it sees as foreign, that is where the immune system attacks and causes the disease to manifest.
Autoimmune diseases have been on the rise for decades worldwide. Autoimmune diseases together constitute the fourth largest cause of death among women. It affects more people than heart disease. It is poorly understood, poorly recognised and of apparent increasing incidence in Africa
In Ghana, 48% of admitted patients die mainly due to late diagnosis and lack of access to proper care and treatment especially more so the newer more disease pathway targeting treatments.
Since they were first introduced in 1998, biologic response modifiers — or biologics — have made a huge difference in the lives of people with autoimmune conditions.
These powerful drugs don’t just treat the symptoms of autoimmune conditions, they work by blocking the effects of the immune system, protecting the body from itself.
Biologics can target the underlying cause, relieving pain and saving the joints from damage. Since the 1990s, the cornerstone of treatment plans has been drugs like called methotrexate others include: Sulfasalazine, Azathioprine, Leflunomide, Hydroxychloroquine and Mycophenolate. Rheumatologists start with these disease modifying drugs called DMARDs as soon as a person is diagnosed with an autoimmune condition. The most commonly prescribed is methotrexate.
The faster a person gets these treatment, the sooner this can slow down or stop the damage to organs.
When you first get diagnosed, you might have doubts about treatment.
If you’re only having mild joint pain or symptoms you may wonder if the risks of biologics and other DMARDs are worth it. Can’t you wait and see how it goes? But a wait-and-see approach can have serious consequences, in some RA cases, the damage may become so severe that even surgery won’t help leading to permanent deformity.
Just like chronic conditions e.g. diabetes and high blood pressure. At first, they might not seem like a problem. But untreated, autoimmune diseases can lead to serious disease and even early death.
Fig 1: Care of a child with autoimmune rheumatic condition
Over time, researchers got a better grasp of how the disease affects the body. That led to the discovery of new parts of the body to focus on, and the development of biologics.
These biologic DMARDs are genetically engineered proteins made from human genes. They’re designed to target parts of your immune system that drive inflammation.
They do so with precision. The greatest advantage of using biologics to treat autoimmune disease is that they can be finely targeted to a specific player in our body’s immune system.
One of the key issues with traditional, oral DMARDs like methotrexate is they take weeks to months to work. But not so with biologics.
In most people who use those, biologics can push the disease into remission. The risks of untreated autoimmune conditions go far beyond achy joints. They include debilitating pain, heart problems, infections, and cancer.
We still don’t have a cure for AIs. But biologics offer hope to people who once had no good options.
When would a Biologic Therapy be needed?
- When treatment with a DMARD alone isn’t working well enough:
This is the most common reason for taking biologics. Studies suggest that the combination of drugs is more powerful than either on their own. NICE guidance
- Failure or intolerance to DMARD by 3 months
- Active joint disease or severe organ involvement
- Side effects from DMARDS.
Some people don’t tolerate oral DMARDS well.
Some health conditions — like liver problems — rule out the use of methotrexate.
In these cases, a rheumatologist might move directly to a biologic.
- You are pregnant or want to become pregnant.
Women with autoimmune conditions should talk to their doctors if they’re considering pregnancy.
Evidence suggests that some — not all — biologics might be safer for pregnant women than methotrexate. However, biologics are not entirely safe for pregnancy
Which type of biologic medication?
Doctors generally can’t predict how well a medicine will work in a person. So we may have to pick and choose.A biologic is often used in combination with methotrexate. You might also need other medicines, like prednisone or painkillers.
The dosage schedules vary widely. They range from twice a week to once every eight weeks and for some every six months.
The type depends on disease subtype. The first ones were known as anti-TNF agents. In other words, they block a substance called tumor necrosis factor. TNF causes joint inflammation and destruction.
When your doctor decides to go the biologics route, you’ll usually get TNF inhibitors first for conditions like rheumatoid arthritis, but for others like lupus, different biologics are used.
Doctors generally don’t use two biologics for rheumatoid arthritis together like they do the DMARDS, because they increase the side effect risks without seeming to increase the benefit.
How is it given? Some biologics are only available intravenously in the hospital . Others can be injected at home by the patient.
If your treatment is helping and your disease is well controlled, you might only need checkups every three to six months
The biggest risk with this whole class of biologic drugs is infection. Minor upper respiratory tract infections are the most common, but tuberculosis TB has been reported with use of drugs like infliximab and adalimumab.
Other rare side effects include demyelinating disease, uveitis, Drug induced lupus , and malignancies.
The most significant barrier is the high cost with average costs of about GHC 28,000.00 to GHC36, 000.00 per year per patient.
Biologics can’t cure autoimmune conditions, but they sure are the passport to the closest to a cure. Remission!