Biologics: targeting the immune signal

Biologics are injected or infused proteins, each targeting one part of the immune process: TNF inhibitors (adalimumab/Humira, etanercept, infliximab and others — the first and most-used), IL-6 blockers (tocilizumab, sarilumab), B-cell depletion (rituximab), and T-cell blockade (abatacept). All produce major improvement and, crucially, slow or stop joint erosion — usually combined with methotrexate. No single class is clearly best to try first; the choice is individualised. Evidence ●●●●●

Because they dial down the immune system, the main risk is infection — including reactivation of latent tuberculosis, which is why everyone is screened for TB and hepatitis before starting. Injection or infusion reactions can occur. Overall, after 20+ years of use across large registries, the long-term safety profile is reasonable and well-characterised. Evidence ●●●●○

Biologics were once staggeringly expensive, but biosimilars — highly similar, equally effective copies — have slashed the cost (adalimumab biosimilars launched at up to ~90% discounts) and hugely widened access. They're a big part of why these drugs are now within reach for far more people. Evidence ●●●●○