Top 10 Biologic Medications in the United States

These drugs are changing the way illnesses are treated

Biologics are drugs made from complex molecules manufactured using living microorganisms, plants, or animal cells. Many are produced using recombinant DNA (rDNA), a technology that involves joining DNA molecules in a laboratory to produce new genetic combinations. Biologics are sometimes referred to as biopharmaceuticals or biological drugs.

Biologics are changing the way healthcare providers treat common conditions. For certain conditions, biologics are becoming more commonly prescribed than traditional drugs. Rheumatoid arthritis, certain cancers, and diabetes have the greatest numbers of dedicated biologic treatments.

This article discusses the top 10 biologic drugs in the United States and what they are used for.

How Biologic Medications Work

Biologic drugs target specific proteins or cells in your body. For example, biologic drugs designed to treat rheumatoid arthritis block certain inflammatory proteins or pro-inflammatory cells. Biologic cancer treatments help the body's own immune system identify and destroy cancer cells.

Biologics don't always work for everyone, and it can be challenging to find the right biologic medication. They can also have severe, sometimes life-threatening side effects.

Generic Biologics

While most drugs are chemicals synthesized from other chemicals, biologics are much more expensive due to their complex manufacturing process. Because of their high cost, there is a great demand for generic versions of biologic medications.

Several pharmaceutical companies are lobbying for the right to manufacture generic versions. However, because they are so difficult to manufacture, there are concerns about the ability to manufacture generics both safely and reliably.

They're not exactly generics, but in recent years, numerous biosimilars have come on the market, usually at a much lower cost than the original biologic they're based on.

Top 10 Biologics

The top 10 biologic drugs all have exceeded the monetary definition of a "blockbuster," meaning they've generated more than $1 billion in annual sales, according to 2017 sales data reported by drug manufacturers.

1

Humira

Woman rubbing hands
Jose Luis Pelaez Inc / Blend Images / Getty Images

The anti-inflammatory drug Humira (adalimumab) is not only the best-selling biologic, it's one of the best-selling drugs worldwide, regardless of class. 

Humira is approved for:

Manufacturer: AbbVie, an Abbott Laboratories spinoff

Global Sales in 2017: $18.4 billion

Generic name: Adalimumab

Launch date: 2002

Side Effects

Humira has risks and can cause serious side effects in some people. Discuss these risks with your healthcare provider before you start taking Humira.

Some of these side effects include:

  • Serious infections including tuberculosis, bacterial sepsis, and invasive fungal infections
  • An increased risk of developing certain cancers such as lymphoma and basal or squamous cell skin cancers

Other, less serious side effects may include:

  • Pain, rash, swelling, or itching at the injection site
  • Upper respiratory infection
  • Headaches
  • Nausea
  • Rash
2

Rituxan

Patient in hospital
BURGER/PHANIE / Canopy / Getty Images

Rituxan (rituximab) was developed by IDEC Pharmaceuticals. It's currently co-marketed in the United States by Biogen Idec and Roche subsidiary Genentech.

Rituxan is approved for:

Manufacturer: Roche

Global Sales in 2017: $9.2 billion

Generic name: Rituximab

Launch date: 1997

Side Effects

It is possible to experience serious side effects while taking Rituxan. These may include:

  • Severe skin reactions including sores and ulcers, blisters, rash, and peeling skin, which may occur on your lips and mouth or on other parts of your body
  • Reactivation of hepatitis B virus in people who are carriers or who have recovered from hepatitis B
  • Progressive multifocal leukoencephalopathy, a serious brain infection that can cause death or severe disability
  • Tumor lysis syndrome, a condition caused by the rapid breakdown of cancer cells that can lead to kidney failure
  • Heart problems such as irregular heartbeat, chest pain, and heart attack
  • Bowel blockage or tears in people taking Rituxan with chemotherapy medications
  • Severe allergic reaction (anaphylaxis)

Other side effects of Rituxan include infusion-related reactions such as nausea, fever or chills, headache, flushing, and shortness of breath.

3

Enbrel

Doctor examining woman's hands
DAM GAULT / SPL / Science Photo Library / Getty Images

Enbrel (etanercept) was developed by researchers at Immunex. Today the drug is co-marketed in North America by Amgen and Pfizer, by Takeda Pharmaceuticals in Japan, and by Wyeth in the rest of the world.

Enbrel is approved for:

  • Rheumatoid arthritis
  • Plaque psoriasis
  • Psoriatic arthritis
  • Polyarticular juvenile idiopathic arthritis
  • Ankylosing spondylitis

Manufacturer: Pfizer/Amgen

Global Sales in 2017: $7.9 billion

Generic name: Etanercept

Launch date: 1998

Side Effects

Enbrel can cause serious side effects such as:

  • New infections or worsening of existing infections, including hepatitis B reactivation
  • New or worsening heart failure
  • Nervous system problems, including multiple sclerosis and seizures
  • Life-threatening blood problems
  • New or worsening psoriasis
  • Severe allergic reaction (anaphylaxis)
  • Autoimmune reactions including autoimmune hepatitis or a condition that causes lupus-like symptoms

Less serious side effects include:

  • Upper respiratory infection
  • Pain, swelling, itching, or rash at the injection site
4

Herceptin

Woman receiving mammogram
Echo / Cultura / Getty Images

Herceptin (trastuzumab) was developed by Genentech, now a Roche subsidiary, and UCLA's Jonsson Comprehensive Cancer Center.

Herceptin is approved for:

Manufacturer: Roche

Global Sales in 2017: $7.4 billion

Generic name: Trastuzumab

Launch date: 1998

Side Effects

Herceptin can cause serious side effects, including infusion reactions that may be fatal. These can include:

  • Increased risk of infection
  • Respiratory distress
  • Severe allergic reaction (anaphylaxis)
  • Low blood pressure

Other serious side effects may include:

  • Damage to the heart or lungs
  • In pregnant women, Herceptin may harm the developing fetus

Less serious side effects include:

  • Fever
  • Nausea and vomiting
  • Diarrhea
  • Cough
  • Headache
  • Fatigue
  • Rash
  • Muscle pain
  • Anemia
5

Avastin

Woman getting a mamogram
Echo / Cultura / Getty Images

When launched in 2004, Genentech's Avastin (bevacizumab) was one of the most expensive drugs on the market, with a $4,400 monthly price tag.

Avastin is approved for:

  • Cervical cancer
  • Hepatocellular cancer
  • Metastatic colorectal cancer 
  • Metastatic renal cell carcinoma
  • Epithelial ovarian, fallopian tube, or peritoneal cancer
  • Glioblastoma
  • Non-squamous non−small cell lung cancer 

Manufacturer: Roche

Global Sales in 2017: $7.1 billion

Generic name: Bevacizumab

Launch date: 2004

Side Effects

Serious side effects of Avastin may include:

  • Bowel or stomach perforation
  • Problems with wound healing
  • Coughing up blood
  • Gastrointestinal, brain, vaginal, or spinal cord bleeding
  • Severe high blood pressure
  • Stroke or heart attack
  • Kidney problems
  • Serious or fatal infusion reactions
  • Nervous system or vision problems including seizure, confusion, and blindness
  • Fistula, an abnormal passage that forms between one part of the body and another

Some less serious side effects may include:

  • Dry skin
  • Watery eyes
  • Change in taste
  • Nosebleeds
  • Headache 
6

Remicade

Woman's skin being examined at doctor
BURGER / PHANIE / Canopy / Getty Images

Remicade (infliximab) was originally developed by Centocor Ortho Biotech, which is now Janssen Biotech, a Johnson & Johnson subsidiary.

Remicade is approved for:

  • Rheumatoid arthritis
  • Crohn's disease
  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Plaque psoriasis
  • Ulcerative colitis

Manufacturer: Johnson & Johnson/Merck & Co.

Global Sales in 2017: $7.1 billion

Generic name: Infliximab

Launch date: 1998

Side Effects

Remicade may cause serious side effects such as:

  • Increased risk of infections including tuberculosis, bacterial sepsis, and fungal infection
  • Increased risk of certain cancers such as lymphoma, cervical cancer, and certain skin cancers
  • Reactivation of hepatitis B
  • New or worsening psoriasis
  • New or worsening heart failure
  • Abnormal heart rhythm, heart attack, and other heart problems
  • Liver injury
  • Blood problems
  • Infusion reactions such as stroke or anaphylaxis
  • An immune condition that causes symptoms similar to lupus

Less serious side effects may include:

  • Upper respiratory infection
  • Cough
  • Stomach pain
  • Headache
7

Lantus

Mom helping son test blood sugar
Tom Merton / Caiaimage / Getty Images

Lantus (insulin glargine injection) was developed at Sanofi-Aventis's biotechnology research center in Frankfurt-Höchst, Germany.

Lantus is approved for:

  • Diabetes

Manufacturer: Sanofi

Global Sales in 2017: $5.7 billion

Generic name: Insulin glargine [rDNA origin] injection

Launch date: 2000

Side Effects

The most common side effect of Lantus is hypoglycemia (low blood sugar). This can be serious and life-threatening. Other serious side effects include:

  • Severe allergic reaction (anaphylaxis)
  • Heart failure in people taking Lantus along with thiazolidinediones

Less serious side effects may include:

  • Weight gain
  • Injection site reactions
  • Low potassium levels
  • Swelling
8

Neulasta

Close up of chemotherapy drip bottle.
Mark Harmel / The Image Bank / Getty Images

Neulasta (pegfilgrastim) is manufactured by Amgen Pharmaceuticals.

Neulasta is approved for:

Manufacturer: Amgen

Global Sales in 2017: $4.7 billion

Generic name: Pegfilgrastim

Launch date: 2002

Side Effects

Neulasta may cause serious side effects, some of which can be life-threatening. These can include:

  • Enlarged or ruptured spleen
  • Respiratory distress
  • Severe allergic reaction (anaphylaxis)
  • Sickle cell crisis in people with sickle cell disease
  • Kidney injury
  • Blood problems, including increased white blood cell count, decreased platelets, and capillary leak syndrome
  • Inflammation of the aortic artery
  • Increased risk of blood cancer

The most common side effect of Neulasta is aching bones or muscles in the arms and/or legs. 

9

Avonex

Nurse feeding patient
Peter Dazeley / Photographer's Choice / Getty Images

In the U.S., Avonex (interferon beta-1α) is marketed in by Biogen Idec and by Merck under the brand name Rebif.

Gemany's Fraunhofer Institute for Interfacial Engineering and Biotechnology IGB and CinnaGen Company cloned Interferon-beta-1α and since 2006 the drug has been sold as CinnoVex, a biosimilar, in Iran.

Avonex/Rebif is approved for:

Manufacturer: Biogen Idec

Global Sales in 2017: $2.1 billion

Generic name: Interferon-beta-1α

Launch date: 1996

Side Effects

Avonex may cause serious side effects in some people. Some of these side effects may be life-threatening.

  • Mental health problems, including depression, hallucinations, and thoughts of suicide
  • New or worsening liver problems, including liver failure
  • Severe allergic reaction (anaphylaxis)
  • Heart problems, including heart failure
  • Blood problems, including low red and white blood cell count and low platelet counts
  • Damage to the small blood vessels
  • High blood pressure in the lungs
  • Seizures
  • Autoimmune conditions such as autoimmune hepatitis and hypo- or hyperthyroidism
  • Serious injection site reactions leading to infection or necrosis (cell death)

Common side effects include flu-like symptoms such as fever, aches, chills, and fever. Injection site reactions such as pain, itching, or redness may also occur. 

10

Lucentis

Eye doctor and patient
Portra Images / DigitalVision / Getty Images

Developed by Genentech, the injectable drug Lucentis (ranibizumab) is marketed in the U.S. by Genentech and outside the U.S. by Novartis.

Lucentis is approved for:

Manufacturer: Roche, Novartis

Global Sales in 2017: $1.5 billion

Generic name: Ranibizumab

Launch date: 2006

Side Effects

Lucentis may cause serious side effects, which may include:

  • Infections of the eye
  • Cataracts
  • Detached retina
  • Blood clots, which can lead to heart attack or stroke

Some of the most common side effects of Lucentis include:

  • Red eyes or eye pain
  • Floaters in the eye
  • Infections of the nose or throat
  • Anemia

Summary

Biologic medications are drugs manufactured from living cells. They work by targeting specific proteins or cells in the body. 

Biologics are used to treat conditions such as immune diseases, cancer, and diabetes. They may not work for everyone, and they can have serious side effects. Be sure to discuss these medications with your healthcare provider before using them.

23 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  9. Enbrel. New to Enbrel? Here are some helpful things to know as you get started.

  10. Food and Drug Administration. Herceptin (trastuzumab) label.

  11. Herceptin. Potential side effects of Herceptin.

  12. Food and Drug Administration. Avastin (bevacizumab injection) label.

  13. Avastin. What are the possible side effects of Avastin?

  14. Food and Drug Administration. Remicade (infliximab) label.

  15. Remicade. Important safety information.

  16. Food and Drug Administration. Lantus (insulin glargine [rDNA origin] injection) label.

  17. Lantus. Once-daily lantus® is the most prescribed Long-acting insulin.

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  21. Avonex. Avonex safety and side effects.

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  23. Lucentis. Lucentis side effects.