The Biologics of Rheumatology Treatments

Joyce Kortan, RN, Arthritis & Rheumatology Consultants Edina, MN

This session focused on differentiating the biologic agents used by rheumatologists, reviewing current drug indications, and identifying new immune modulators.

Joyce Kortan, RN started the session off asking, "What is a biologic?" and "What is an antigen?" After giving a quick answers, she discussed monocole antibodies which are used for rheumatology treatments. Studies have demonstrated that researchers are taking a page out of the oncology book and are developing therapeutic monoclonal antibodies to target a very specific location in the body; Kortan referred to this as "exquisite specificity."

Patients with rheumatoid arthritis (RA) or other inflammatory diseases have an abundance of tumor necrosis factor (TNF) in their bodies. Rheumatologists must use anti-TNF is treat this problem because blocking TNF gives the patients relief of their disorder. Also, anti-TNF can actually kill the cells (reverse signaling).

Kortan really stressed how important B-cells and T-cells are and that they are dependent on one another. They produce excess cytonkines and produce auto antibodies. She said, "Sometimes these two cells have to have two handshakes."

Current and new treatments

Kortan reviewed the indications of widely prescribed medications by reviewing what is written on the package inserts. The drugs that she discussed were:

• Etancercept (Enbrel)
• Infliximab (Remicade)
• Adilimumab (Humira)
• Rituximab (Rituxan; not a first-line treatment)
• Abatacept (Orencia)
• Golimumab (CNTO 148)
• Certolizumab Pegol (Cimzia)

Kortan also discussed the biologics of new immune modulators, focusing a lot on IL-6 and it's role in rheumatoid arthritis pathogenesis, referencing tocilizumab (Actemra). Other new treatments were ustekimumab (recently approved), ocrelizumab (in clinical trial), atacicept, and belimumb.

Patient education

Because healthcare professionals only give pamphlets and go over the mechanism of action of a drug(s) with the patient, Kortan decided that it was important to offer formal patient education to explain everything in lay-mans-terms. She came up with a proposal, which was approved by the practice, and started a two-day per month class to sort through treatment biologics and their associated infections and risk; when to call the healthcare professional; and answer questions about lymphoma and drug safety. She explained that patients who do not understand their treatment are more likely stop taking them. However, of the patients who participated in the classes, "98% were still on their prescribed biologics." The practice has not been billing the patients for this extra service, but Kortan explained that the practice intends to research this option.