If you have an autoimmune disease, it’s likely you’ve heard the term “biologics” at some point or another. But perhaps you’re wondering what this term actually means, why biologics have their own special drug category, or why your health care provider is suggesting these specific drugs in the first place. Here, we’ll give you all the information you need about what biologics are and their benefits and risks, and share some complementary options.

What Is a Biologic Drug?

A biologic, also called a biologic drug, is a type of medication made from biological sources. More specifically, biologic drugs are made from natural sources, such as microorganisms, living cells, or bacteria. They are made from many different proteins, DNA, or sugars, and are complicated to make. (Source)

Biologics are at the cutting edge of technology in medicine. These drugs are designed to target specific proteins or cells in the body that are resulting in physical symptoms, making them an effective treatment option for a variety of health conditions, such as autoimmune diseases, cancer, kidney disease, and other chronic illnesses. (Source)

Biologics are commonly used medications — in fact, the top selling drug in the world in 2021 was Humira (adalimumab), a biologic used for autoimmune conditions such as rheumatoid arthritis, ankylosing spondylitis, psoriasis, and Crohn’s disease. (Source, Source)

How Are Biologics Different From Other Drugs?

Biologics are different from conventional drugs, which are known as small molecule drugs because they are made of simple, small chemical materials. Small molecule drugs are easier to make and are often much more affordable than biologic drugs because their development and manufacturing are simpler. Biologics, conversely, are large, complex molecules which are costly to develop. (Source, Source)

What Are the Benefits of Biologics?

Biologics can offer a number of benefits over conventional drugs. One of the most significant benefits is their ability to target specific proteins or cells in the body, which reduces the risk of off-target side effects. Conventional drugs, by comparison, are generally less targeted and may act broadly across the body, making side effects more likely. Additionally, because biologics are made from living materials, they are often more effective at treating conditions that are caused by an over- or underactive immune system. (Source, Source)

The ultimate benefit of biologic drugs is resolution of symptoms. This can be especially true for those patients who use biologics as a second or third treatment option, which is often the case with biologics. For many patients, the biologic will be the drug that worked when conventional drugs did not — for example, many people with ankylosing spondylitis will first try and fail with NSAIDs before trying a biologic. (Source, Source)

What Are the Types of Biologics?

There are several different types of biologics. If you have an autoimmune condition, you’re most likely to encounter monoclonal antibodies, cytokines, and vaccines.

• monoclonal antibodies: These are artificial proteins created to specifically target and neutralize harmful proteins in the body. These biologics are often used to treat autoimmune diseases such as rheumatoid arthritis and psoriasis, as well as some types of cancer.
• cytokines: These are designed to modify the immune system’s response to a particular condition. These drugs can be used to stimulate the immune system to fight off an infection, or to suppress it in the case of autoimmune diseases.
• vaccines: These drugs are designed to stimulate the immune system to produce an immune response against specific pathogens, such as bacteria and viruses. This type of biologic is used to prevent a variety of diseases, including influenza, pneumonia, and human papilloma virus (HPV).

(Source, Source, Source)

How Are Biologics Taken?

Biologics are typically administered through an injection under the skin or infusion into a vein, rather than taken by mouth. This is because they are vulnerable to being broken down by acid in the stomach, and because their large molecular size makes it hard for them to pass out of the intestinal lining into the bloodstream. However, oral and inhaled options are in development as potential dosage forms. (Source, Source)

Which Autoimmune Disorders Do Biologics Treat?

Biologics are usually prescribed for complex, chronic conditions. Some autoimmune conditions biologics may be used to treat include:

• rheumatoid arthritis
• plaque psoriasis
• psoriasis arthritis
• inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
• uveitis
• ankylosing spondylitis
• hidradenitis suppurativa
• juvenile idiopathic arthritis
• systemic lupus erythematosus

(Source, Source, Source, Source)

How Do Biologics Work?

Biologics work by targeting specific proteins, cells, or pathways that are involved in the development and progression of a disease. For example, for someone with an inflammatory autoimmune condition, a biologic can block the action of a specific protein that causes the inflammation. There are many types of biologics, partly because there are many different types of proteins that can cause inflammation. This is also why certain biologics are better suited to treat specific conditions. (Source, Source, Source)

What Is a Biosimilar?

If you’re speaking with your health care provider about taking a biologic, the term “biosimilar” may come up in the conversation. A biosimilar is a drug that is highly similar to a biologic drug that is already approved by the U.S. Food and Drug Administration (FDA). The FDA officially describes a biosimilar as a biologic drug that has no clinically meaningful differences from the original biologic, also known as the reference product. This means the biosimilar will have the same mechanism of action, way of being administered, treatment benefits, and risk of side effects. Biosimilars are often suggested as more economical options. (Source)

A simple way to think about a biosimilar is like a generic, “off-brand” version of the biologic drug, in the same way store-brand ibuprofen subs for Advil. However, the nuance is a bit more complex — while the generic ibuprofen will be identical to Advil, the biosimilar has natural slight variations. Because biologic drugs are derived from living materials, there are minor, naturally occurring variations between all batches, meaning they will not be exactly identical. However, before being approved, biosimilars go through extensive testing to ensure there are no meaningful differences in benefits or safety between the biosimilar and the brand-name biologic drug. (Source, Source)

Going back to the mention of economics, just as generics cost less than brand-name drugs, biosimilars are a more affordable alternative to existing biologic drugs. Some insurance companies or hospitals prefer patients to go on the biosimilar option to save money, so you may be offered the biosimilar instead of the brand name. However, insurance coverage varies, so be sure to check your plan. If you have questions about why you’ve been prescribed a specific drug, you should always consult your health care provider. (Source)

Are There Risks to Taking Biologics or Biosimilars?

As with all drugs, taking a biologic or biosimilar comes with a risk of side effects. The type of side effect varies depending on the specific medication, but the most common side effects of biologics are:

• injection or infusion site reactions. You could have some swelling or redness at the area where the biologic is administered, which will typically resolve on its own. However, you should talk with your health care provider if it lasts more than a few days.
• allergies or other immune reactions. This can occur because biologics are designed to modify the immune system’s response to a particular condition, which can sometimes cause an adverse reaction.
• infection. Because some biologic drugs suppress your immune system in order to treat the condition, you may be at an increased risk of infection.

(Source, Source, Source, Source, Source)

For any new drug you’re taking, it’s a good idea to read the informational pamphlet that will come with the product. The full list of potential side effects will be listed there, which will give you an idea of what to look out for.

Another potential risk to keep in mind is the cost. As mentioned, biologic drugs are often more expensive to develop and as a result may be quite expensive, sometimes costing thousands of dollars a month. Certain insurance providers may also have a preference for which biologics they cover, so be sure to check the costs before you start treatment. (Source, Source)

Complementary Management of Autoimmune Disease

Biologics have changed medical treatment for numerous conditions, autoimmune and otherwise — but as we know, the body is a complex place, and what works for your body is highly personal. Keep in mind that there are many alternatives to managing your autoimmune disease aside from using biologic drugs. These same alternate methods may be great complementary approaches to use in conjunction with your biologic.

For example, better sleep, nutrition, and physical movement have been shown to significantly affect how you feel when you have an autoimmune condition. These can also have the added benefit of lowering your stress level, which can be a double benefit. Even something as simple as going outside for a walk or taking a deep breath can lower your cortisol levels. Using a whole-body approach that incorporates lifestyle changes, which may or may not include medication, can be hugely beneficial. WellTheory has many resources to get you started, and if you’re looking for more personalized support, connect with the WellTheory Care Team.

The Bottom Line on Biologics

Biologics are a type of complex medication derived from natural sources, which differs from standard small molecule drugs made from simpler chemicals. Biologics are used to treat a variety of conditions, including autoimmune diseases, cancer, and infectious diseases. Biologics have several benefits, including being more targeted and specific in their effects and having fewer side effects than traditional drugs. However, they also carry some risks, such as allergic reactions and infections.

If you’ve been offered a biologic drug, it’s important to discuss the benefits and risks with your health care professional to make sure it’s the right option for you. And if you’re interested in learning about complementary approaches to managing your autoimmune condition, the WellTheory team is here to help. Get a personalized nutrition and lifestyle plan that is specifically targeted towards individuals with autoimmunity and takes your whole body into account.