Biologics are engineered proteins that block one specific signal in the immune system, such as TNF, IL-6, IL-17 or B-cells. JAK inhibitors (tofacitinib, baricitinib, upadacitinib) are tablets that block signalling inside immune cells. Both are used when the disease is still active despite conventional DMARDs, or in ankylosing spondylitis when anti-inflammatory painkillers are not enough. Biosimilars, which are equivalent copies of the original biologics, have made treatment far more affordable in India.
How long it takes
Often within 2 to 12 weeks, depending on the drug.
How to take it
- Most biologics are self-injected under the skin at home every one to four weeks. The clinic teaches you or a family member how.
- Some are given as a drip (infusion) in a day-care unit every few weeks or months.
- JAK inhibitors are tablets, taken once or twice a day.
- Injection pens are kept in the refrigerator (not the freezer). Ask about travel arrangements before a trip.
Common side effects
Most are mild and many settle. Mention them at your next visit; there is often a simple fix.
- Redness or itching where an injection was given
- More frequent minor infections such as colds and urinary infections
- Headache
- JAK inhibitors: raised cholesterol on blood tests
Call the clinic the same day if you have
- Fever, or any infection needing antibiotics. The next dose is usually held until you are better.
- A cough lasting more than two to three weeks, night sweats or weight loss, which can be signs of TB
- A painful blistering rash on one side of the body (shingles)
- Pain and swelling in one calf, or sudden breathlessness
Clinic: +91 70571 19999. If you are very unwell, go to the nearest emergency department and take your medicine strip with you.
Blood tests & checks
- Before starting: screening for latent TB (IGRA or Mantoux test with a chest X-ray), hepatitis B and C, and usually HIV
- Vaccinations brought up to date before the first dose where possible
- Blood count and liver tests at intervals; cholesterol for some drugs
Pregnancy & family planning
- Several TNF-blocking biologics can be continued through some or all of pregnancy with planning. Discuss it before conceiving if you can.
- JAK inhibitors are stopped before trying to conceive.
- If you received a biologic late in pregnancy, tell the paediatrician: live vaccines for the baby, including BCG, which is given at birth in India, are usually delayed for the first six months.
Alcohol, infections, vaccines & other medicines
Tuberculosis
TB is common in India, and these drugs can wake up a dormant infection. That is why screening is never skipped, and why a lingering cough must be reported.
Surgery
Doses are usually paused around planned operations. Tell the clinic as soon as surgery is scheduled.
Vaccines
Inactivated vaccines (flu, pneumococcal, COVID-19, and the non-live shingles vaccine) are recommended. Live vaccines are avoided while on treatment.
Heart and clot risk with JAK inhibitors
In people over 65, smokers, or those with heart disease or previous blood clots, the choice between a JAK inhibitor and a biologic is weighed carefully.