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- Hi today, we're gonna talk about the risks, benefits
and some side-effects of immunomodulator drugs,
which are, of course, biologics or JAK inhibitors.
So direct-to-consumer advertising,
the commercials you see on TV,
do mention some pretty scary side effects.
The biggest question that I'm asked by patients
is the risk of cancers like lymphoma.
I explain it like this.
If you had a stadium that had 10,000 seats in it,
and nobody in that stadium had RA,
then possibly two people in that stadium
may end up with lymphoma.
Now, if everybody in that stadium did have RA,
possibly four people would have lymphoma.
And if everybody in that stadium had RA
and was taking a biologic drug,
it still would be four people possibly getting lymphoma.
So the problem is you are more susceptible
because you have the disease,
rather than because you have a specific drug
that you're taking.
Now, the law says that the pharmaceutical companies
must report any type of side effect that happens.
So they are reporting lymphomas,
and that's why you hear about that.
You need to consider what will happen
if you don't choose to take medications.
You may have worsening of your disease,
you can going to end up with deformities,
you may end up disabled,
and so it's really important to weigh that
against any potential risk.
So let's talk about a few side effects of biologics.
One of the first things
is you may be susceptible to infection.
So what we do at the standard of care
is to get a tuberculosis test before starting
and to test for hepatitis B and C.
So we look at those and we make sure
that we've got treatment going
before we would start the biologic medication.
The other thing is we look at how susceptible you may be
to infections anyway,
and we're able to monitor, then, what is happening
should you get an infection while you're on a biologic.
So some of the things that we would do
is if a patient got an infection
and needed to go on an antibiotic,
then we would ask you to hold your biologic
while you took that antibiotic,
and then you could restart it after you finished.
Another infection that we have to be aware of
are perhaps zoster infections, or what's called shingles.
So what we often like to do is make sure
that a patient can get a shingles vaccine
before they start a biologic or a JAK inhibitor.
The incidence of shingles is higher
on JAK inhibitor medication.
But again, if we can get vaccines into people,
then that usually won't be a problem.
Now, another thing that's interesting with JAK inhibitors
and IL-6 inhibitors are what are called thrombotic events.
And this is like a deep vein thrombosis
or a pulmonary embolism.
Now, like with lymphoma, patients with RA
or other inflammatory arthritides are at an increased risk
for thrombotic events.
What we wanna do is if you have a history
of a thrombotic event,
we probably would not start a JAK inhibitor
or an IL-6 inhibitor.
Another issue are GI perforations,
which would mean a perforation or a hole in the bowel.
And these have been seen, again,
with JAK inhibitors and IL-6 inhibitors.
And so if a patient has a history of diverticulitis,
where they've had issues
or other types of colon type of issues,
then we probably, again, would not start those medications
in those particular patients.
Now, what we do is we monitor blood work,
and we monitor your symptoms.
Every time you come to see us,
your blood work may be done
every three months to six months,
and we follow those blood counts,
look at liver function tests,
and we even look at your cholesterol levels.
Now, another thing to be aware of as far as cancer goes
is that nonmelanoma skin cancers are more common
in patients taking biologics.
The nonmelanoma skin cancers are basal cell cancers
or squamous cell cancers.
And those are often easily treated
within the dermatologist's office.
But we do recommend that you have a dermatologist,
and that you see a dermatologist
at least once a year for an annual skin check.
And then of course we would recommend
that people are religious in using their sunscreens.
Solid tumors like breast cancer, colon cancer, lung cancer
do not appear to be increased
compared to the general population
with patients taking biologics.
If you are on an injectable biologic, a pen or a syringe,
you may have an injection site reaction.
If this reaction is bigger than about a half dollar size,
you should give us a call.
Generally, these can be controlled with some ice
after you do the injection,
or even before you do the injection,
or some type of an anti-itch cream.
They seem to clear up.
But again, if this becomes troublesome,
please contact your rheumatologist.
Now, infusion reactions can happen in those patients
who are receiving their medication by IV.
So your infusion center nurse
should go over any types of symptoms with you,
but just be aware if something doesn't feel right,
you would notify your nurse and let them know
if you have any tickle in your throat
or itching, burning, anything unexpected.
Now lastly, I'll talk about elective surgery.
So if you were going to have an elective surgery,
we really need you to hold your medication
before that surgery.
It could be two weeks or more before the surgery,
so please call your rheumatologist, give them a heads up
that you're going to have an elective surgery,
and then they will discuss with you
how soon they want you to hold your medication
and then when you can restart.
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