When it comes to the treatment of rheumatic diseases such as rheumatoid arthritis, lupusand psoriatic arthritisThere are more medicines available than ever before. Medicines that slow the progression of a rheumatic disease are called disease-modifying anti-rheumatic drugs, or DMARDs. Most DMARDs fall into two main categories: conventional synthetic DMARDs and biologic DMARDs. Targeted synthetic DMARDs are a third category and include drugs such as upadacitinib which targets a signaling protein involved in inflammation. Despite these three drug categories, rheumatology healthcare professionals often refer to conventional synthetic DMARDs as “DMARDs” and biologic DMARDs as “biologics.”

This article will provide a brief overview of these two main categories: “DMARDs” and “Biologics”.

Examples:

Advantages:

• Conventional DMARDs have been available for a long time and have been studied mostly in terms of how well they work and potential complications or side effects.
• These medications are usually less expensive compared to biologics, making them more accessible to patients.

Disadvantages:

• It may take several weeks or even months for patients to feel the full benefits of conventional DMARDs.
• Some people may experience side effects such as nausea, hair loss or liver problems.
• Patients need regular blood tests to check for any side effects on their liver or blood cells.

Biologics (bDMARDs)
This group contains drugs that have been developed more recently than conventional DMARDs. These medicines are called biologics because they contain proteins made from living sources (plant, bacterial, human or animal cells). Medicines in this group are too complex to be made into a pill and are taken as injections under the skin or as an infusion into a vein. Biologics were designed to block specific parts of the immune system involved in causing inflammation. A biosimilar drug is a biological drug that is a close copy, but not an identical copy, of a biological drug.

Some examples include:

Advantages:

• Unlike pills, these medications don’t need to be broken down by your digestive system to be absorbed by your body, so they typically don’t cause side effects that sometimes occur with some pills, such as stomach irritation, nausea, or diarrhea.
• Most biologics require less frequent dosing because they last for several days, weeks, or even months compared to a once- or twice-daily pill.

Disadvantages:

• Biologics tend to be more expensive than conventional DMARDs, making them less accessible to some patients.
• Biologic drugs are given as injections or infusions.
• Because biologics suppress the immune system, patients may be at higher risk of infections, including serious ones like tuberculosis.
• In some cases, a patient’s immune system will react to biologics as if they were an infection and make proteins that attack the medicine.

Comparison:

• Conventional DMARDs are generally more affordable than biologics.
• Both types of medication can cause side effects, but biologics may have fewer side effects that affect the whole body because they target specific parts of the immune system.
• Conventional DMARDs are usually taken orally, while biologics are administered through injections or infusions.
• Regular blood tests to monitor for side effects may be necessary for some medications in both groups.

Both conventional synthetic DMARDs and biologics can be effective in controlling rheumatic diseases. Medicines from both groups can be taken individually or in combination with other medicines depending on various factors, including the severity of symptoms, cost, potential side effects and personal preference. It is important for patients to discuss their options with their healthcare professionals to find the treatment plan that works best for them. Both types of medicine play a crucial role in managing rheumatic diseases and improving patients’ quality of life.