Biologics For Autoimmune Diseases – A New Treatment For Children by Dr. Sagar Bhattad

These biologics target certain parts of your immune system to work on instead of the disease itself. They work by reducing or alleviating the inflammations caused as a result of your immune system fighting the disease. When the inflammations reduce, your pain and discomfort come down. This results in an improvement in the quality of life.

Biologic drugs and powerful and effective in many cases. They help in areas where conventional chemical-based medications or treatments have not helped much. However, it is not always positive news with these drugs. They can have a negative impact on the body too.

What are Autoimmune Diseases?

Autoimmune diseases are a group of diseases or conditions for which the reasons and in most cases, the cure is still unknown. These diseases are also known as idiopathic meaning that the origin of these diseases is not known.

Your genetics, the environment you live in, and certain other factors can cause an autoimmune disease in you.

Let us take a quick look at some of the factors that can be responsible for autoimmune diseases.

1. Genetic Factors

Autoimmune diseases are genetic which means that a child can get it from a parent or a grandparent. Parents can inherit the tendency for the condition from their parents. When they have a child, they pass on this defective gene to the child. The defective gene can take precedence or lie dormant. When the gene is active, it spreads the disease to the next generation, meaning the child. The disease has effectively transferred from one generation to another.

Now, one cannot determine if the disease will be the same, milder or more serious in the next generation. This is because the child has another set of genes from the other parent. So, if those genes are stronger in the child, the disease’ impact can be milder. However, if the defective gene is stronger, the impact of the disease can be stronger.

2. Environmental Factors

Exposure to environmental hazards is quite common today. Though we cannot conclude these can cause disease, we cannot fully rule out the possibility either. Doctors and researchers acknowledge that this is a type of exposure we have no control over. No one knows if certain exposures can lead to autoimmune diseases.

Environmental exposures can include cigarette smoke, factory pollution, fumes, and many other such chemicals. Studies conclude that constant exposure to certain harmful environmental factors can be responsible for autoimmune diseases.

3. Additional Factors

Your body can react strongly to certain medications too. Continuous usage of some medicine might trigger your immune system to overwork in order to protect the body, but in reality, it might end up hurting the body instead.

Certain infections if left unchecked or not treated in time can lead to diseases that can be classified as autoimmune as many of them have no cure even if it is not genetic.

How Are Biologics For Autoimmune Diseases Made?

Biologics are either made from living cells or based on certain living organisms. Biologic drugs are manufactured from a living source or products of a living source like humans or animals.

Do Biologics For Autoimmune Diseases Work?

Yes. These drugs are specially formulated to target specific areas of your body and reduce inflammation in those areas. This is why they are used for treating rheumatoid arthritis, Crohn’s disease and the like.

How Do Autoimmune Diseases Work?

The autoimmune disease causes a malfunction of the immune system. The immune system which is supposed to protect your body will attack it instead in case of an autoimmune disease.

Normally, the immune system produces antibodies when it recognizes some foreign invaders in the body. These antibodies are specifically designed to attack that particular foreign invader/ infection. In the case of an autoimmune disease, the immune system mistakes the healthy cells of the body to be foreign invaders and produce antibodies to attack them. As a result, the immune system attacks the healthy cells of the body, thereby causing the body to become weak.

As these healthy cells will not go away like an infection, the immune system will continue to produce antibodies to fight these cells. In the due course, the body becomes weak as healthy cells get destroyed, the immune system becomes weak due to the lack of healthy cells, and the body becomes vulnerable to multiple other infections and foreign invaders.

So, a person with an autoimmune disease does not get affected by that disease alone; they are prone to many other infections which eventually compromise their quality of life. Though there are many medications for various autoimmune diseases, there is no permanent cure. Medicines can only help control the disease and keep it in check. This enables the patient to lead a better and healthier life.

Do Biologics Work For Everyone?

No, unfortunately not. It is not possible to categorise what biologic drug will work to what extent for whom. Different drugs work differently for different people. What might be very successful for one patient might cause severe side effects for another, with a similar disease or health condition?

Your doctor will try the most commonly used biologic for your condition. If it doesn’t work for you, they will try a different biologic or some other option. Since it is made from live organisms and targets how your immune system responds to the disease, it can stop working anytime too. If your immune system does not cooperate or stops cooperating, the drug will not be effective for you anymore.

The doctor might use a single biologic drug or a combination of these drugs, based on your health condition. Since different inflammatory diseases behave differently and can be triggered by various reasons, you might need more than just one biological drug.

What Types of Biologics Are Available to Treat Autoimmune Diseases?

There are several types of biologics. We shall discuss the four main types of biologics, designed to target different types of inflammations. Each of these has its own set of benefits and side effects.

1. Tumour Necrosis Factor (TNF) Inhibitors

The white blood cells in our body produce a protein called Tumour Necrosis Factor (TNF). It is the role of this TNF to trigger inflammations in the body as a response to infections. However, in the case of patients with rheumatoid arthritis, the TNF triggers such inflammations unnecessarily. It can cause a lot of pain in the patient.

TNF inhibitors are the most common type of biologics. In the case of rheumatoid arthritis, these inhibitors block such inflammations and stop the disease’s progress. Doctors recommend these inhibitors to children with Juvenile Idiopathic Arthritis and Uveitis when routine medications fail to control the disease. Adalimumab, infliximab and etanercept are some common medications in this group.

2. B-Cell Inhibitors

B-cells are an important part of the immune system. They are a part of the white blood cells (lymphocytes) and are responsible for the immune system’s response to infection. The B-Cell inhibitors will target the protein that is responsible for the B cells’ response. By reducing the activity of these B cells, the inhibitors reduce the immune system’s response, however, the body gets prone to infections. Rituximab is a commonly used B-cell inhibitor.

3. Interleukin Inhibitors

Just like the above two inhibitors, the Interleukin (IL) inhibitors also target a protein. The protein called IL proteins is also responsible for inflammations. In the case of patients with an autoimmune disease, IL-1 and IL-6 (types of interleukin) are found in excess. These inhibitors such as Anakinra and Tocilizumab will block these proteins to stop the disease from progressing any further.

4. Selective Costimulation Modulators

The most common type of Biologics in this group is Abatacept. Doctors are using this to treat children suffering from Juvenile idiopathic arthritis. Your child may notice a reduction in swelling or joint pain after a minimum of 4 – 6 weeks of using this medicine. You will start seeing positive results after 6 months of using this medicine. This biological medicine along with therapy can work much better on the disease.

How Are Biologics Given to Children?

There are two ways of giving biologics to children.

1. As an injection under the skin (subcutaneous)
2. Through an IV infusion

For an injection, you need not always take the help of a medical professional. Trained family members can give it too. For IV infusion, you will have to do it under medical supervision.

Children suffering from psoriasis, juvenile idiopathic arthritis, uveitis, systemic lupus erythematosus, myositis and a few other autoimmune conditions can get biologics. These conditions can be quite difficult for children. In such situations, the benefits of the biologics to the child will outweigh the side effects. For this reason, scientists and doctors are approving them for children with autoimmune conditions.

Are Biologics Safe For Children?

The impact of Biologics on the paediatric population is different from that of the adult population. Not all biologics approved for adults can be used for children. There is limited data on the usage and impact of the approved biologics on children either.

Most of the data available about using Biologics to treat children is restricted to JIA. There is not much data for other diseases. As a result, there is not much information on the impact or side effects of biologics on children.

Side Effects of Biologics For Autoimmune Diseases in Children

As mentioned above, the impact of approved Biologics on children is still unknown. Research and data collection are ongoing to understand their effects on children. When it comes to adults, there is more data about the use of biologics. For kids, experts believe that biologics can cause the same amount of side effects, or sometimes, even more.

Different Biologics work differently for different patients. Some may suffer mild side effects while some may suffer serious side effects, while some may suffer none at all.

Common Side Effects From Biologics

Some of the common side effects you can expect from the use of biologics are

• Itching
• Swelling
• Redness
• Pain

Side Effects From Biologics Injections

When you get a biologics injection, in addition to the above, you may experience the following mild side effects

• Flushing: The injection site might flare up making the area look flushed, which can slowly spread through the body too
• Headaches: This is very common not just with Biologics but other strong medicines as well
• Nausea: Injecting such medicines can cause stomach upsets

These are not serious and will subside on their own within a few days. If you notice them flare-up or not subside even after 5 days, you need to inform your doctor.

Serious Side Effects From Biologics

Some of the more serious side effects one can experience by using biologics are:

• Breathing trouble
• Tightening of the chest
• Chest pain
• Fever
• Severe allergic reaction
• High/low blood pressure
• Swelling in hands or face

Factors Influencing the Side Effects

The extent of side effects depends on many factors. The factors influencing these side effects include

1. Type of Biologic

Different types of Biologics have different reactions. The type of the biologic plays a vital role in the side effects. If one medication does not work well for you, the doctor will move to another type or a combination. If nothing works, they might look at other chemical-based medicines for options.

2. Mode of Administration

Your doctor will administer Biologics as an injection or through an IV. Side effects will depend on the mode of administration. Injections will have a different set of side effects from IVs.

3. Site of Injection

The side effects also depend on the site of the injection and the way your body reacts to this. If the injection is given in the right spot in the right manner, the side effects will be minimal. The biologic will also start working will and you will observe a positive improvement in the autoimmune condition. On the contrary, if given in the wrong spot (not medically but subjectively), it might cause you more harm or side effects.

4. Progress of the Disease

How far along is the disease has a direct impact on how the drug works. If the autoimmune disease (eg., Juvenile arthritis) has caused severe damage to the body, the biologic might not work well, and the body might even react negatively to it.

5. Other Underlying Diseases or Health Issues

If you have other health conditions, they can interfere with the biologics. If you are under medications for those ailments, the medicines can react with the biologics, causing serious side effects.

Risks of Using Biologics For Autoimmune Diseases

It is important to understand the risk factors associated with this treatment for your child before starting therapy. This will help you prepare for eventualities and understand your child better.

1. Weakening the Immune System

In most cases, Biologics can weaken your immunity, making you vulnerable to other infections. Biologics target certain locations in the body where the inflammations are high or painful. Inflammation is the immune system’s way of fighting invaders. When controlling of this process, the immune system becomes weak. As a result, it cannot effectively fight off other regular infections. These infections need not be anything strong or serious. It can be something as simple as a common cold, sinus infection; or a little more serious like UTIs, upper respiratory infections or bronchitis.

2. Infections Can Return

In some cases, the use of Biologics can reactivate certain infections that have been dormant for a while. When you use Biologics for some disease, it can help with that condition but in the meantime, can reactivate the dormant infection. It is important to let your doctor know if you have had these diseases and have undergone treatment for them in the past. The doctor should also ideally check you for these infections before they start you with Biologics.

Biologics are made from live organisms and are making big headway in curing or at least maintaining some of the difficult autoimmune diseases. They are successfully working for adults but are yet to reach children. Biologics are a new revolution in the treatment of autoimmune diseases. These advances in medical science are helping treat autoimmune conditions where other modes of treatments are not showing results.

If your child’s doctor suggests biologics as a form of treatment, do not hesitate to ask all the questions and some more. This is your child, and you need you must have enough information and knowledge to handle any situation. Consult a Pediatric Rheumatologist and he/she will be in a position to guide you on this matter better.

[Read : My Child is Diagnosed With Henoch Schonlein Purpura(HSP) ]

FAQ’s

1. How Long Do You Stay on Biologics?

An average adult human body will take about 4 – 6 weeks to show any impact of the biologics itself. It takes time to feel the full effects. Doctors normally prescribe the biologics for 6-12 months. The total duration will depend on the person’s response to the medication.

2. What Are the Four Most Common Autoimmune Diseases in Children?

The Four most common autoimmune diseases in children are

• Juvenile Idiopathic arthritis
• Vasculitis – Kawasaki disease
• Henoch Schonlein purpura
• Systemic lupus erythematosus

3. Do Biologics Cause Weight Gain in Children?

Most biologics do not cause weight gain, unlike steroids which cause weight gain in most patients.

4. Steroids or Biologics – Which One is Better?

Steroids are like bombs, while biologics are like bullets. While steroids work quickly and help control an autoimmune disease, you cannot take them or give them to your child for long time. This is because steroids cause many side effects – weight gain, weaken the bones, increased infections, cataracts etc. On the other hand, biologics work on a particular target in the immune system. They have more specific actions and hence cause fewer side effects.

Read Also: Steroids in Children – Are They Always Harmful? by Dr. Sagar Bhattad