Is Enbrel an effective RA treatment

Biologics

A subgroup of the basic drugs are the biologics, in clinical parlance also referred to with the English word biologicals.

These are biotechnologically produced protein substances that are directed against certain inflammatory messenger substances in the body or directly against immune cells. In the immune system, a number of messenger substances are responsible for mediating the inflammatory processes in the body; One of the very important messenger substances in chronic inflammation is tumor necrosis factor alpha. Tumor necrosis factor alpha inhibitors are used, among other things, in severe forms of rheumatoid arthritis.

The following biologics for the treatment of rheumatic diseases are on the German market, for example: Adalimumab, Etanercept, Infliximab, Golimumab and Certolizumab, all of which inhibit the disease-promoting effects of tumor necrosis factor alpha, abatacept (blocks T lymphocyte activation), anakinra and canakinumab (work against interleukin-1), belimumab and rituximab (reduce the number of B lymphocytes), secukinumab (acts against interleukin-17A), ustekinumab (acts against interleukin-12 and interleukin-23) and the interleukin-6 blocker tocilizumab. Further biologics are listed in the table.

The first biological medicines “similar to biologicals” are now available. These are imitation products of an already approved, biotechnologically produced original biologic. The copycat products are only similar to the original products. They are not the same. In order to differentiate the imitation product and the original, these biologics are grouped under the name “biosimilars”. The first biosimilars for the treatment of inflammatory rheumatic diseases have been available on the German market since 2015. The first three are called (active ingredient name in brackets): Remsima® (infliximab), Inflectra® (infliximab) and Benepali® (etanercept).

In order to distinguish between original biologics and biosimilars, the English term "bDMARD" is divided into two groups:

Biological: bDMARD

  • Original biological: boDMARD
  • Biosimilar: bsDMARD

Compared to the classic basic drugs (csDMARDs), the biologicals act faster and effectively stop the progression of the disease. However, in rheumatoid arthritis, for example, they are only used when the classic basic therapy with csDMARDs fails, as the disease is well under control in many patients if the conventional basic therapy is used in good time. The significantly higher costs of biologics must also be considered and little is known about possible dangerous long-term effects.
 

Biologics approved in the field of rheumatology in the European Union:

(This does not necessarily mean that the respective biosimilar is already available on the German market; as of March 2021)

 

  • Active ingredient name: Abatacept (blocker of T lymphocyte activation)
    Trade name: Orencia®
     
  • Active ingredient name: Adalimumab (TNF-alpha blocker)
    Trade name: Humira®; Biosimilars: Amgevita®, Imraldi®, Hyrimoz®, Hulio®, Idacio®, Hefiya®, Amsparity®, Yuflyma®
  • Active ingredient name: Anakinra (interleukin-1 blocker)
    Trade name: Kineret®
     
  • Active ingredient name: Belimumab (decreases the number of B lymphocytes)
    Trade name: Benlysta®
     
  • Active ingredient name: Canakinumab (interleukin-1 blocker)
    Trade name: Ilaris®
     
  • Active ingredient name: Certolizumab Pegol (TNF-alpha blocker)
    Trade name: Cimzia®
     
  • Name of active ingredient: Denosumab (interferes with bone metabolism)
    Trade name: Prolia®
     
  • Active ingredient name: Etanercept (TNF-alpha blocker)
    Trade name: Enbrel®; Biosimilars: Benepali®, Erelzi®, Nepexto®
     
  • Active ingredient name: Golimumab (TNF-alpha blocker)
    Trade name: Simponi®
  • Active ingredient name: Guselkumab (interleukin-23 blocker)
    Trade name: Tremfya®
  • Active ingredient name: Infliximab (TNF-alpha blocker)
    Trade name: Remicade®; Biosimilars: Inflectra®, Remsima®, Flixabi®, Zessly®
     
  • Active ingredient name: Ixekizumab (interleukin-17A blocker)
    Trade name: Taltz®
     
  • Name of active substance: Rituximab (antibody against CD20 positive B lymphocytes)
    Trade name: MabThera®; Biosimilars: Truxima®, Ritemvia®, Rixathon®, Riximyo®, Ruxience®
     
  • Active ingredient name: Romosozumab (interferes with bone metabolism)
    Trade name: Evenity®
     
  • Active ingredient name: Sarilumab (IL-6 receptor blocker)
    Trade name: Kevzara®
     
  • Active ingredient name: Secukinumab (interleukin-17A blocker)
    Trade name: Cosentyx®
     
  • Active ingredient name: Teriparatide (interferes with bone metabolism)
    Trade name: Forsteo®; Biosimilars: Terrosa®, Movymia®, Livogiva®
  • Active ingredient name: Tocilizumab (interleukin-6 blocker)
    Trade name: RoActemra®
     
  • Name of active substance: ustekinumab (interleukin-12 and interleukin-23 blockers)
    Trade name: Stelara®