Ask an Expert: Biologic response modifiers (BRMs)

Q: I’ve heard about new “biologic” therapies for the treatment of rheumatoid arthritis. How do these medicines work? 

Answer from Peter Bonafede, M.D., medical director of the Providence Arthritis Center at Providence Portland Medical Center:

Biologic response modifiers (BRMs) are drugs designed to help the body fight inflammation. These drugs get into the immune system and "turn off" chemical substances in the body that cause inflammation, thus offering some relief from joint pain, swelling and damage. 

BRMs are a relatively new class of drugs that have helped some individuals with rheumatoid arthritis, psoriatric arthritis and psoriasis. Four such drugs on the market are Enbrel, Humira and Kineret, which are given by self-injection, and Remicade, which is administered intravenously. Minor side effects can include pain and swelling in the area where the injection is given, but this is usually temporary. More signficant side effects have been observed in rare cases and require more study to determine if they are linked to the use of BRMs; these include an increased incidence of infections, the aggravation of symptoms related to multiple sclerosis, and an increased incidence of lymphomas.

BRMs are extremely expensive and do not work for everyone, so they are typically not the first treatment of choice for individuals with arthritis. You and your physician might discuss them as an option, however, if you have a particularly agressive form of arthitis that does not respond to standard treatments.

November 2003