You may have heard of biologics before. These medical or pharmaceutical products are often seen as the cutting-edge of biomedical research and used as efficient therapies.
But biologics aren’t new: insulin, human growth hormone, or red-blood cell stimulating agents, for example, have been discovered decades ago and widely used since then.
What's new, however, is the scope of application biologics are now used for. The increasing knowledge of genetics and understanding of our bodies and immune systems has led to the discovery of new biological drugs now available as powerful therapies for numerous chronic health conditions.
Biologics are now prescribed or under clinical trials for a wide variety of diseases, including diabetes, anemia, rheumatoid arthritis, cancers, hepatitis, Parkinson's disease, and dozens of others. They represent a new hope where conventional drugs have failed to relieve or cure numerous patients.
But what are they exactly? What are biological drugs? How are they different from conventional ones? How do they work? What are they used for?
What are biologics?
Biologics, also known as biological drugs or biopharmaceuticals, are a class of FDA-regulated drugs produced with biological sources using a living system such as an animal cell, a plant cell, or a microorganism.
Biologics include a wide range of products, including vaccines, blood components, allergens, somatic cells, genes, tissues, recombinant therapeutic proteins, antibodies, enzymes, hormones, and others. Most of them are administered via injection or infusion, and very few can be taken by mouth.
Biologics are difficult to manufacture and use cutting-edge technologies. The process of making biological drugs is called biomanufacturing and involves reproducing or growing copies of a specially engineered living cell.
Biological drugs are different from most drugs that are chemically synthesized and made with small molecules. Because they’re made from living sources, they often involve a part of uncertainty in their development. It can explain why biological drugs are typically more expensive than non-biological treatments.
Besides, biologics tend to be unstable products, heat sensitive, and susceptible to microbial contamination. That’s why most biological drugs like insulin, growth hormones, TNF inhibitors, GLP-1 agonist drugs, and others require specific storage conditions and often refrigeration.
Types of biologics
There are different types of biologics used for different therapies, including:
- Vaccines
- Blood and blood components (like red blood cells, plasma, or platelets)
- Recombinant proteins (like insulin, human growth hormones, or erythropoietin)
- Steroid hormone therapies (like estrogen and testosterone)
- Monoclonal antibodies to treat autoimmune diseases and cancers
- Interleukins immune molecules for specific cancer treatments
- Stem cell therapies
- Gene therapies for genetic health conditions
- Tendons, ligaments, and tissues used for transplantation
- Others
How do biologics work?
As seen above, biologics is a vast class of drugs and includes different things used for various purposes. But biological therapies are generally more target-specific than chemically produced drugs.
Biologics are commonly used for autoimmune diseases where the body abnormally attacks its own cells, like type 1 diabetes, rheumatoid arthritis, multiple sclerosis, or Crohn's disease.
Unlike older traditional drugs for autoimmune diseases that used to tone down the entire immune system response, biological drugs tend to work in a more targeted and precise way. They block specific parts of your immune system only, the ones responsible for your disease and symptoms.
Biologics side effects
Biologics are potent drugs that can sometimes cause serious side effects, especially when interfering with our immune system. However, it's such a wide range of medicines and therapies that there's not one list of side effects that could apply to all biologics.
Before taking a specific biological drug, your doctor should inform you about its potential mild or severe side effects. Make sure you understand, and don't hesitate to ask for more information. Biological therapies are often considered when other treatments have failed.
What are biologics used for?
The number of biologics on the market keeps multiplying every year. Many types of biological therapy are now available to treat a wide variety of medical conditions, including numerous autoimmune diseases and forms of cancers such as:
- Type 1 and type 2 diabetes
- Rheumatoid arthritis
- Psoriasis
- Inflammatory bowel diseases
- Crohn’s disease
- Multiple sclerosis
- Macular degeneration
- Colon cancer
- Breast cancer
- Leukemia
- Lymphoma
- Infertility
- Osteoporosis
- Fibrosis
- Hemophilia
- Growth hormone deficiency
- Others
Now, let’s focus on some of the most common uses of biologics.
Biologics for Rheumatoid arthritis
Rheumatoid arthritis is an autoimmune disorder where the body’s immune system attacks its own tissue, causing chronic inflammation of the joints and sometimes internal organs.
While most cases can be managed with oral non-biologic anti-rheumatic drugs like methotrexate, sulfasalazine, hydroxychloroquine, or leflunomide, more severe cases may require biologics. Conventional anti-rheumatic drugs suppress the immune system response, whereas biologics block specific parts of the immune system only, such as the proteins that promote joint inflammation.
Most biologics used to treat rheumatoid arthritis are given via self-injection or intravenous infusion. The most common ones are:
- Tumor necrosis factor (TNF) inhibitors, the most widely prescribed biologics for rheumatoid arthritis, such as Humira (adalimumab), Cimzia (certolizumab pegol), Enbrel (etanercept), Simponi (golimumab), or Remicade (infliximab).
- Selective co-stimulation modulators like Orencia (abatacept).
- B-cell inhibitors like Benlysta (belimumab) or Rituxan (rituximab).
- Interleukin inhibitors like Kevzara (sarilumab), Taltz, Cosentyx, Kineret (anakinra), Actemra (tocilizumab), Stelara (ustekinumab), or others.
Choosing one biologic instead of the other to treat rheumatoid arthritis when conventional drugs have failed can be difficult. Some biological drugs for rheumatoid arthritis may work for some patients and not for others. In addition, each biologic comes with a unique inflammatory target, as well as its own risks and benefits. Ask for your doctor's advice.
Related article: Tips for traveling with rheumatoid or psoriatic arthritis.
Biologics for Diabetes
Diabetes is a chronic health condition causing high blood sugar levels. Biologic medications are also commonly used to manage diabetes. For example, insulin, the only treatment for high blood sugars in type 1 diabetes (an autoimmune disease), is a biologic.
But patients with type 2 diabetes may also be prescribed biological drugs to help lower their blood sugar, including insulin, but also:
Biologics used to treat diabetes are all delivered via self-injections. In the case of type 2 diabetes, they’re often combined with smaller molecule drugs like Metformin or Januvia, for example.
Related article: Why does insulin need to be refrigerated?
Biologics for Ulcerative Colitis, Crohn’s, and IBDs
Inflammatory bowel diseases are long-term health conditions that characterize by chronic inflammation of the gastrointestinal tract. The most common ones are ulcerative colitis and Crohn’s disease.
Biologics and biosimilar therapies may also be used to treat people with ulcerative colitis and Crohn’s disease.
Unlike corticosteroid drugs widely prescribed for IBDs that affect the whole body and may cause major side effects, biological therapies act more selectively by targeting particular proteins responsible for IBDs.
Biologics available for patients with IBDs or ulcerative colitis are often the same as for rheumatoid arthritis and include Humira, Stelara, Tysabri, Entyvio, and others. As for rheumatoid arthritis, you may have to try different biologics until you find the one that works for you.
Related article: Is there a link between IBD, Crohn’s disease, and diabetes?
Biologics for Asthma
Asthma is a chronic condition affecting the airways in the lungs, often causing inflammation. Most cases can be managed with rescue inhalers (curative) or controller inhalers (preventive), but severe asthma may require longer-acting drugs, as well as oral steroids or biologics.
There are currently 5 FDA-approved biologics for asthma:
- Dupixent (dupilumab)
- Xolair (omalizumab)
- Nucala (mepolizumab)
- Cinqair (reslizumab)
- Fasenra (benralizumab)
They all work differently on the causes of asthma. For example, Xolair targets allergy antibodies, while Nucala, Cinqair, and Fasenra target the pathways that affect a cell involved in allergic inflammation known as IgE. On the other hand, Dupixent acts on a receptor for two molecules known to drive allergic inflammation.
Like any biological drug, your doctor will run tests to help decide which is best for you.
Related article: Safety tips for traveling with mild or severe asthma.
Biologics for Eczema
Eczema or atopic dermatitis is an inflammatory skin condition that causes itchiness, rashes, blisters, and skin infections. There are currently two FDA-approved biologics for atopic dermatitis:
- Dupixent (dupilumab)
- Adbry (tralokinumab)
They both belong to the class of monoclonal antibodies biologics. They’re proteins made in laboratories that act like the natural antibodies produced by our body’s immune system to fight injections. Dupixent and Adbry help strengthen the skin's ability to protect from germs and irritants and stop the immune system from turning on the inflammation process.
Related article: How to enjoy the beach when you have eczema?
Biologics for cancer
Cancer is another medical field where biological therapy is widely used. Biologics can induce the body's immune system to recognize and kill cancer cells, slowing tumor growth or preventing cancer spread.
There are several types of biological therapies for cancers, including numerous ones currently in clinical trials. So, it's a very active area of medical research.
