Dosage

Since the bilogikas are usually proteins, they must be given parenterally (via an infusion). Oral administration is not possible, as the body would then digest them and the active ingredients would not be able to exert their effect. The dosage depends on the active ingredient and the disease in question. Usually the dose is in the one to two-digit milligram range and is administered 1-2 times a week.

Price

The costs of biologics are very high. Therefore they are usually only used as a last resort. That is, if all other agents indicated for the respective diseases are not successful. As a rule, two injections in one month cost around 1,600 euros.

Side effects

Under specialist treatment and observation, TNF-α blockers are relatively well tolerated and safe drugs. Nevertheless, as with any drug, side effects may occur. The side effects can be divided into those related to the application and those related to the intervention in the immune system.

Since the Biologikas have to be given parenterally (as an infusion), infusion reactions can theoretically occur. In comparison to other biologics, this happens more frequently with the active ingredient Infliximab. However, under specialist treatment, these types of side effects can usually be well controlled.

If biologics are given subcutaneously (under the skin), local skin reactions can be triggered. However, it has rarely been necessary to discontinue therapy. Side effects that occur due to the intervention in the immune system are based on the additional suppression of physiological processes in our body.

The messenger substance TNF-α is actually an important inflammation modulator. Even if it is partially directed against the immune system, it has important tasks around the immune defence. If these important functions of TNF-α are permanently blocked by drugs, this can lead to corresponding side effects.

The susceptibility to infections can increase and the risk of cancer can also possibly increase with long-term use. Damage to the liver, kidney and heart can occur. In addition, the TNF-α inhibitors can reactivate inactive tuberculosis and herpes zoster.

Depending on the generation of monoclonal antibodies, the risk of intolerance and allergy is higher or lower. This means that the more mouse protein is still present in the active substance, the greater the risk of allergies and intolerances. In addition, certain autoantibodies can occur.

Rarely, a so-called lupus erythematosus developed due to treatment with a TNF-α inhibitor. The incidence of lupus erythematosus decreased again when the patient stopped taking the biological agent. In addition, various diseases and relapses in the context of multiple sclerosis as well as deterioration in severe heart failure have been described.

Interaction

If vaccinations are given with live vaccines and TNF-α inhibitors at the same time, this can cause a disease with the vaccine pathogen instead of a vaccination effect. Furthermore, an interaction could be observed when combining two biologicals. For example, this was observed when Etanercept and Anakinra were administered simultaneously as part of the treatment of rheumatoid arthritis. There was no improved effect, but a potentiation of the side effects. Severe infections and a lack of certain blood cells occurred, so that a so-called neutropenia developed.