For our last blog, we continued a series of how specific biologic medications work.
Rituxan was the first medication presented in February 2018 and last week we shared how anti-TNF biologics work. This was prompted by a patient asking me to express in writing what I verbally explain when someone is starting this medication.
There are many inflammatory substances produced in the human body. In rheumatoid arthritis, two inflammatory substances have been identified that are made in excess. One is TNF (tumour necrosis factor) and the second is interleuken-6, known as IL-6. Whereas TNF can be made in excess in many autoimmune conditions, IL-6 is only made in excess in the joints of people with rheumatoid arthritis. There are five treatments approved by Health Canada that remove TNF and these were featured in last week’s blog. There are two approved biologics that remove IL-6:
- Sarilumab (Kevzara)- taken every other week by pre-filled syringe
- Tocilizumab (Actemra)- taken every other week or weekly depending on the person’s weight. An intravenous form is also available and given monthly.
Treatments which remove IL-6 or TNF have an equal chance of putting a person with rheumatoid arthritis in low disease activity or remission.
As with all biologics used in autoimmune conditions, the risk of infection is a little greater than in the general public and therefore updating adult vaccines is suggested. Anti-I-L-6 therapies are not given when someone is experiencing an active infection.
These treatments not used in patients who have diverticulitis. Regular blood work is done to measure liver enzymes and a complete blood count. Anti-IL-6 medications may increase both the “good” cholesterol HDL and the “bad” cholesterol LDL, but due to their ability to lower inflammation in blood vessels, they are considered protective against cardiovascular disease.
Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.