Biotherapies in Medical Practice: A Review and the Nigerian Experience

Biologics or Biological agents are pharmaceuticals manufactured, extracted from or semi synthesized from biological sources and used in the diagnosis, treatment or prevention of diseases. When used for rheumatic diseases, they are monoclonal antibodies targeting wide range of peptide mediators (cytokines), receptors and cells. They have complex structures and are about 200 to 1000 times larger than chemical molecule drugs. Biologics are being increasingly used in auto immune rheumatic and non-rheumatic diseases, especially when synthetic immunosuppressive have failed. They are also useful in various other auto immune diseases in other systems. There are a lot of these agents available depending on the targeted cytokine. Biologics use in rheumatic disease, rheumatoid arthritis was first documented in Nigeria in 2007. Ever since then, the two available biologics in Nigeria, Etanercept( Enbrel) and Rituximab( Mabthera) have been used in the management of diverse conditions. Many of the indications have been off label. While their efficacies are not in doubt, however their cost is prohibitive, and adverse effects are sometimes seen. This review describes the evolution of biotherapy, mode of action of biologics, indications for their use and challenges. It also gives our experience in the use of these agents among Nigerian patients seen in a private practice rheumatology clinic between 2007-2019.