Rheumatoid arthritis (RA) is one of the most common types of inflammatory joint diseases in America. 41 out of every 100,000 people in the US are diagnosed with this disease every year. In the past few years, a new type of RA medication has been developed. It belongs to the biological DMARD drug class and comes in injection or infusion form. Infusion isn’t a common administration route for many medications. Thus, many RA patients may have some questions about this type of drug delivery route. In this blog, we’ll answer some of the most common questions about infusion therapy for RA, including what to expect before, during, and after the infusion.
1. What is infusion therapy for rheumatoid arthritis?
Before explaining what infusion therapy for RA is, we need to step back and look at the four types of RA medications: nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, disease-modifying anti-rheumatic drugs (DMARDs), and biological DMARDs (bDMARDs). Infusion therapy is a part of bDMARDs, or also popularly known as ‘biologics’.
As an engineered protein drug, biologics work by affecting certain protein that is responsible for causing joint inflammation and consequently, hold back the progression of RA. Biologics may not heal RA, but they can significantly slow down the damage in the joints.
Almost all bDMARDs come in liquid form and can only be given to patients through injection or infusion. As you can probably guess, ‘infusion therapy’ is a term to describe the process of administering biological drugs via infusion. Unlike other common RA drugs (such as DMARD), biologics can’t be given orally as they need to be delivered directly into the bloodstream.
If you are interested in learning more about the various categories of RA medications, the differences between them, and their side effects, check out our Rheumatoid Arthritis: Conventional vs Biological Therapies blog.
2. Why infusion therapy?
One key advantage of taking infusion therapy is that bDMARDs tend to work more quickly and effectively than conventional DMARDs. The genetically engineered proteins can target different parts of the immune system to stop them from attacking your joints and ultimately decrease joint inflammation and tissue damage.
Infusion therapy is usually prescribed when non-biological DMARD medications, such as methotrexate (Trexall), hydroxychloroquine (Plaquenil), and leflunomide (Arava), aren’t responding well to you. You may also be given non-biological DMARD medications, such as methotrexate, in tandem with infusion therapy.
3. Which infusion medications will I receive?
Some of the most common biological drugs for infusion therapy are abatacept (Orencia), golimumab (Simponi Aria), infliximab (Remicade), rituximab (Rituxan), and tocilizumab (Actemra). Talk with your doctor to decide which drug you will take. The decision will mainly be based on your diagnosis, your health history, how your immune system works against the drug, and your health insurance.
4. How much does infusion therapy cost?
Biologics can be incredibly expensive. Of all therapies for RA, biologics make up the greatest share of overall costs per year. Here are some estimated overall costs of infusions per patient per year for different infusion drugs: rituximab $36,663, tocilizumab $36,821, infliximab $44,973, and abatacept $46,532.
Unfortunately, many health insurances only cover one or two of the medications used for RA infusion therapy. As previously mentioned, the drug that you will receive is likely to be based on which one(s) your insurance covers. You may also incur copays or are eligible for deductibles. Some patients may also choose to join financial assistance programs that are offered by many pharmaceutical companies to help cover medication costs. You can see the list here
5. How does getting an infusion work exactly?
As the term suggests, the infusion process works just like when you receive regular IV therapy. After an IV is hooked in your hand or arm, the liquid medication is “infused” into your body through a vein. During the infusion, you may find it helpful to do something relaxing, such as reading or playing a video game on your phone.
6. Where is infusion therapy administered?
Unlike injectable bDMARDs, you can’t administer the drug on your own at home. You have to go to a hospital or an infusion clinic to receive infusion therapy medications. The facility provided in each infusion room may differ from one another, but they have one common goal: to make people feel comfortable while receiving their infusion medications.
In many infusion rooms, you may find recliners, blankets, pillows, and even a TV. You can sleep during the infusion period, watch your favorite TV shows, or work on your computer. If you want, you may also ask your loved ones to accompany you during the treatment.
7. How long does infusion therapy take?
The infusion time may take between 15 minutes and four hours or more. It depends on several factors such as the medications themselves (they vary from one manufacturer to another, some may have one standard dose, some may not), your tolerance, and your weight. For example, Remicade infusion can take about three hours and Simponi Aria infusion may take only 30 minutes.
8. How long after the infusion will I feel the improvement?
You won’t feel the effect of the medication right away as infusion therapy doesn’t work like painkillers. Some people may notice an improvement after getting the first infusion in the first couple of weeks, while others may feel it in months. Additionally, some people may not feel the progress after the first infusion session, but after the second, third, or even the fourth. Keep in mind that everyone reacts differently to the medications and it is important to stick to the treatment plan. Try your best to stay on the treatment schedule as it can influence the effectiveness of the medication.
9. Does infusion therapy hurt?
You may feel like you’re being pinched when the needle for the IV is put in, but once the infusion liquid starts to go in, you won’t feel it flowing to your body. If the idea of needles or getting your hand/arm hooked to an IV makes you feel anxious, discuss it with your doctor. They may give you a drug, such as Benadryl, to help you relax during the infusion session.
10. What are the side effects of infusion therapy?
Just like any biological drug, infusions may cause some side effects. Generally, mild side effects include injection site reactions (redness, itching, pain, and swelling), nausea, and headache (can be caused by fluid imbalance). Some of the more serious side effects can include allergic reactions (itching, hives, and flushing), increased risk of infection, blood clots in the lungs, tuberculosis, and trouble breathing.
Furthermore, each drug can cause different side effects and may not be suitable for certain people due to their medical history. Ask your doctor to review your health conditions (including those from the past) and discuss the possible outcomes of taking a certain infusion medication before deciding the drug you will take.
Conclusion: Is infusion therapy for me?
Infusion therapy can be a game-changer for treating RA, especially for those whose conditions aren’t getting better after being treated with other types of RA medications. It can prevent the inflammation to become worse more effectively than the orally administered RA drugs (such as hydroxychloroquine, leflunomide, or sulfasalazine). Additionally, infusion therapy can also be suitable for patients who don’t want to give themselves shots at home. That being said, because of the high cost, infusion therapy may not be accessible for some people. Talk with your doctor and check your health insurance coverage. If infusion therapy (bDMARD) is not recommended for you, you can opt for the DMARD which comes from the same drug group but is given orally and is usually more budget friendly.
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