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"Don't take that drug! It killed my mom!" - (1/21/2020)

By Dr. Ron Gasbarro

Barb came into the pharmacy to pick up some prescriptions. She said to the pharmacist, “I think I saved my friend’s life! Her doctor recommended that she take this one drug for her psoriasis. I told her that's the same drug my mom took for her rheumatoid arthritis, and it killed her." While talking more with Barb, the pharmacist discovered that the medication her friend’s doctor prescribed was in a relatively new class of drugs called biologics. 

What is a biologic? Unlike traditional drugs that are made using a non-living chemical process, biologics are manufactured within living cells – cells that come from humans, animals, and microorganisms. While many conventional drugs are orally administered, biologics must be infused via the veins. Why? They are huge, complex molecules. Yet, they are very unstable and can be destroyed by adverse environmental conditions, such as the hydrochloric acid and digestive enzymes in the gastrointestinal tract. 

Vaccines were the first biologics. In 1797, physician Edward Jenner developed history’s first widely used vaccine, for smallpox, a disease that ravaged Europe throughout the Middle Ages. In 1922, a physician gave a 14-year old Canadian diabetic the first injection of insulin, another biologic. Since then, biologics are increasingly an option in treating diseases that affect the immune system, such as rheumatoid arthritis, psoriasis, ulcerative colitis (UC), Crohn’s disease, multiple sclerosis, lupus, and many other conditions that have burdened the human race. Their ads have flooded television and print.

Yet, why would Barb tell her friend that they cause cancer if these drugs are so helpful? Medical myths can go viral once they are created, usually borne of misinformation, blaming the drug rather than the big picture. Even to this day, many people think vaccines can cause autism, despite the stack of clinical studies that debunk that claim. Analyzing whether biologics cause malignancies has been the focus of much research. For example, a 2015 analysis of over 12,000 patients enrolled in the Psoriasis Longitudinal Assessment and Registry revealed that none of the biologics the patients used were associated with increased risk for cancer. Other studies reached similar conclusions.

However, the patient may still have doubts. “I’ve had cancer. I’m afraid of these new drugs.” “My UC is painful enough, but cancer would be so much worse.” Should patients forego therapy that might improve the quality of their life because of a remote chance that a malignancy may occur? In people with a history of cancer, the benefits of biologic therapy to improve quality of life often outweigh the minor risks for cancer. However, physicians should refer such patients to an oncologist before initiating biologic treatment. Because some cancers are hereditary, such as breast cancer, family history is especially important. The pharmacist knew that Barb’s mother had a family history of cancer. And yes, Barb’s mom succumbed to that disease. However, for Barb to scare her friend and say that all biologics cause cancer based on one event is plainly wrong. Ideally, a pharmacist could advise the friend about any potential side effects of the prescribed drug rather than opt not to receive the therapy.   

Biologics are not always medicine’s better angels. Because biologics suppress the immune system to control the disease, patients are at a higher risk for severe and possibly life-threatening infections. Asking questions from healthcare professionals – physicians, nurses, and pharmacists – should allay the fears of the patient who will better know what to expect from biologic therapy.

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.com. 

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