PEARLS No. 217, December 2009, written by Brian R McAvoy

Clinical question
How effective are biologics in patients with rheumatoid arthritis (RA)?  

Bottom line
Abatacept, adalimumab, etanercept, infliximab, rituximab and (to a lesser extent) anakinra may improve signs of rheumatoid arthritis, including the number of tender or swollen joints and other outcomes, such as pain and disability. Fewer withdrawals due to adverse effects were reported for etanercept than for adalimumab, anakinra and infliximab.  

Caveat
The findings should be interpreted with caution due to heterogeneity in the characteristics of trial populations. There is insufficient information about possible side effects and complications. This is particularly true for rare but serious side effects. Possible side effects may include a serious infection or upper respiratory infection. An association between use of biologics and an increased rate of lymphomas has been reported. Most of the trials lasted only 6 to 12 months.  

Context
Biologics are a group of disease-modifying anti-rheumatic drugs that suppress the immune system and reduce inflammation in the joints. Suppressing the immune system can make it slightly harder to "fight off" infections but also helps to stabilise an overactive immune system. The aim of treatment is to help prevent damage to the joints by reducing inflammation.  

Cochrane Systematic Review
Singh JA et al. Biologics for rheumatoid arthritis: an overview of Cochrane reviews. Cochrane Reviews 2009, Issue 4. Article No. CD007848. DOI: 10.1002/14651858.CD007848.pub2. This overview covers 6 Cochrane reviews involving 31 studies and more than 9500 participants. One study did not report the number of participants.