First off, thanks to all for your patience with all of my questions!
With regard to the biologics like Humira, Enbrel, and Remicade, I've noticed that many of you here seem to take them in conjunction with MTX or mention that they were added to MTX/replaced MTX if it didn't work.
Are biologics considered DMARDs, too? Is there a reason why they seem to be prescribed after MTX?
Do doctors ever prescribe a biologic first (before MTX)?
Do the biologics contain similar risks and side effects to MTX?
Thanks very much!
Christina
I have no idea, but I'm gonna bump this to the top for you, because I know there are other people who CAN answer this for you!!!!I take Humira & pred. I do not take it with conjunction with anything like MTX or Arava, because MTX did not help me made me worse and Arava, I just refuse to take ever again, plus I had bad side effects from it.
Humira works ok for me by itself, but I have to have the pred, to help with the swelling and being able to move when Humira starts to wear off.
As for your other questions, I cannot really answer, as I am not sure my answer will be correct.
Hope my Reply kinda helped ya.
There's a very informative program you can view on:
http://www.medscape.com/resource/rheumarthritis
You have to register for a free account before you can log on. The link to the program is located near the center of the page; called: "Biologics...". It's long and you have to wade through a lot of technical jargon but in the end it's very informative. The speaker shows plots of follow-up studies spanning 6 years which show how well the biologics work with and without MTX. Combination therapy is definitely more effective though biologics alone are still more effective than MTX. I think the reason they are not prescribed first is primarily due to insurance restrictions due to the cost. A DMARD is a drug that slows or stops the joint damage due to RA...as evidenced by x-rays...biologics are definitely DMARDS as shown in some of the plots in the presentation. I haven't seen a comparison between the risks of MTX and the biologics...in my case the side effects of Humira are substantially less than the side effects of MTX. The risks of the biologics are small and as time passes concern seems to be less than was originally thought.
Alan
PS:
The presentation on Medscape also shows data from the Orencia and Rituximab (??) trials which are B and T cell suppressors instead of TNF-inhibitors. The data shows that both drugs are very effective for people who have had no success with the TNF inhibitors. Another interesting fact is that the 6 year follow studies show no decline in the effectiveness of the biologics, which seems contrary to a lot of testimonials I've seen on the board suggesting that they stop working after a couple of years.
You can flip through the slides if you don't want to listen to the entire presentation.
Alan
You all are wonderful--thanks so much for responding!
Alan, I'm going to sign up for access to that website now and read up on them--an excellent reference, thanks!
Biologics are all injectable, right? I did just look at my insurance coverage, and injectable drugs are only covered 20% (and not to exceed ). I know some of you mentioned that Enbrel is 0 month... did I get that right? Ouch.
Is there the immuno-suppression on biologics that there is on MTX?
Christine, there are lots of places you can get assistance for your biologics, even the companies that make them have assistance programs. So don't let the cost of them hinder your decision. There's a way around everything!I took Humira for two years after being on MTX for two years before that. I paid just a month as a co-pay with my insurance but if I had to pay out of pocket it would have been about 00 a month (For weekly injections)! It's expensive stuff and I can only imagine insurance companies don't want to dish that out unless you've tried other things first. Personally I think that's a good policy. MTX alone worked well alone for me for a long time; but that's not always the case with everyone. There are also a lot of folks that can't tolerate MTX like I've been able to either and for those it's a great option if your doctor and insurance company will allow it. It's next to impossible to be on a biologic without insurance due to the cost. Now if you've got tons on money then that's great.....but if you're that rich it's rediculous not to have insurance so that doesn't make any sense I guess.
Are you considering a biologic? I'd highly recommend it if you've tried other medications and still aren't under control. It helped me dramatically.
Good Luck.
[QUOTE=Lovie]Are you considering a biologic? I'd highly recommend it if you've tried other medications and still aren't under control. It helped me dramatically.
[/QUOTE]
Hi Lovie, and thanks for the info. Actually, I've not even been diagnosed yet, but am just gathering information incessantly for my first RD appointment in September--my preference would be to avoid the MTX and go right to the biologics, but I'm not sure if that's how it works (with there being a choice, that is).
We do ahve insurance, but I looked today and they will only cover 20% of injectables (not to exceed /month). We have choices with our insurance, but if we switched after I've been officially diagnosed, then I think I'd be considered as having "pre-existing condition" and they could refuse covering the biologics. Catch-22!
Thanks for weighing in, though--and Katie, as I PMed you, thanks for the info on the financial aid from the drug companies. I'm going to look into that, too!
Christina
DrM. I take MXT inj. with Remicade infusions. Most likely your RD will prescribe MXT to begin with for about a 3-6 month period to see if it's effective. If not there are other meds, plaquenil, sulfa, PA therapy, before you start into the bigger guns. If you have damage and it's advancing quickly then they'll skip over those drugs and go straight to the big guns. That's what my RD did. I tried Enbrel and then went straight to Remicade and MXT.
Alan gave you the website with the best info.
Also, some insurance companies will override and pay for the injectibles at whatever your usual outpatient benefits are. Not all companies but some do. MXT inj. isn't too costly and would be affordable but the biologics are a different matter. You need a letter of medical necessity from your RD and submit with the request for meds to be paid as outpatient benefits or at you 80/20 or whatever your benefits are. Remicade runs me about ,800 every 6 weeks and my copay is .00. I'm blessed and I know it and I never take it for granted. It's really worth fighting your insurance company for more coverage if possible. Frustrating but worth it. Lindy
Hi Christine,
I was told that MTX is usually the first line of attack as compared to biologics it is cheaper and less harmful side effects. In the UK you can only get biologics is you've tried MTX or another (sulfa I think) and they've failed or you can't tolerate them. My Dr prefers to give MTX with biologics as it helps them to work. I was on infliximab (remicade) and MTX is best with that as it is made of mouse proteins and you can develop an allergic reaction to it, the MTX stops your body fighting the drugs... I am now on etanercept (enbrel) and still taking MTX as a kind of two-pronged attack on the PA. BUT every Dr has different theories and every patient reaccts differently. I think that the side effects are different ffor wach type of drug and it's a case of working out which one suits you best (ie try them and see!). I found MTX OK at 10mg (current dose) but can't tolerate 12.5mg. It's not enough on its own though - although could be at a hogher dose if I could cope with it! With PA some Dr's are slow to begin aggressive treatment because some forms of PA are not as damaging. Luckily I saw a Dr who knows his PA and realised I was on a slippery slope and falling fast so he was more aggressive in his treatment - as soon as the MTX was clearly not working I went onto infliximab and now after 11 months of that am on etanercept, not sure where I can go after this though...
I hope my ramblings are helpful!
KT
What worries you most about MTX? Alot of the side effects that people fear so much are unlikely to happen to many. For those that can tolerate MTX it's a life saver! I wish I had been offered it in the early days; but then again maybe not. Over time all medications seem to loose their effectiveness and you then have to move onto high doses and over time stronger medications. If you start out on the stronger medications what do you then switch to when they too loose their effect? You won't have many options.
If your RA (If you are dx'ed) is mild to moderate as it's likely to be you'll want to start out on the most effective lesser treatment possible. RA is a disease that will last a life time I'm afraid. Pase yourself and work your way up the ladder of treatments if possible. Most doctors work this way. It would be nice if the strongest medication would "cure" us right away and then we'd be done with it....but I'm afraid that's just not the way it works.
Try not to rule out any medication until you've had a chance to research all the facts and get as many opinions as possible.
Christina--You've got lots of good info here!Thanks so much for all the thoughtful responses! You truly are such a kind and patient group.
I realize now that I had it backwards--I wasn't actually trying to solve my issues faster with biologics; rather, I don't use any medication unless I have to, and I was assuming that the biologics were milder than MTX. I realize now from all of these responses that MTX, although scary, is actually the sensible place to begin.
I guess the "Side Effects of MTX" thread freaked me out a bit more than I thought it would. KT just gave me some great ideas on how to start out at very low dosages and increase a little week by week to see how I'm tolerating it, so I know that's an option I can discuss with my doctor.
Lovie, to answer your question, what's been scaring me about MTX is the immunosuppression, the hair loss (I'm so sorry, I know that sounds horribly vain and ridiculous in the overall scheme of things, but, well, there it is), and the possible liver damage. I'm 37, and while a glass of wine is the extent of my drinking now, I truly used to overdo it in my younger days when I was in my early 20s, so I'm just worried I may have shot myself in the foot during the years I thought I was invincible. But the doc does test your liver counts prior to prescribing everything, I'm sure.
Dordale8, you are so right in that I shouldn't rule anything out. Thanks for adding to my research!
Thanks again!
You aren't being vein. I'm a woman myself and at 36 I'm not too ashamed to say I too don't want to loose my hair! BUT; like I said, not everything listed happens to everyone. (I've had no problem with that at all) As far as the drinking goes I drink several glasses of wine a week. My doctors fine with it. After about 5 years now I have always tested fine when my liver was monitored. There's no way to know who will have problems and who won't. I know folks that have had problems with MTX and liver issues and never drink at all and then there are folks like me that have some now and then and have no problems at all.
MTX has been used to treat RA for a really long time. We have folks here that have been on it for 10 year or more. One has used it for 14 or 15. Biologics are newer and although I myself had great success with Humira I have to admit they haven't really been around long enough yet to truly know in my opinion. I think the fact that MTX is a cancer drug worries many people and they have nightmare of major hairloss and to my knowledge that sort of hairloss just doesn't happen.
At this point if I had any advice for you I'd say research things like Sulfersalizine and Plaquinel. These are two DMARDS that I used in the early years when my RA wasn't quite as aggressive as it is now. I honestly believe that these medications bought me a lot of time and would encourage you and all other's just starting out to discuss these less invasive treatments with your doctors.
Searching this site for information will certainly give you a leg up but don't get too far ahead of yourself. Some of the treatments discussed here can do more harm than good used under the wrong circumstances. Luckily the majority of the actual medication choice will be up to your doctor. It will serve you good though to show your doctor that you understand what's going on right from the start. I noticed my doctors all treat me differently once they realize I've done some research on my own and it's been good to see that my doctor takes my suggestions seriously and often supports my choice as far as to what road we go down next. The relationship with your RD will be a long term relationship sadly often out living some marriages (Sorry that's a sick but true joke in my case).
I wish I had these kinds of websites to visit in the early days while I was trying to understand all this stuff. The doctors can never tell you enough despite some of their best efforts.
Lovie, what a great post--thank you!
First of all, I'm so sorry about your marriage. That must have been very difficult.
When you mentioned "getting ahead of yourself," it's good advice and I totally agree. It's why I wish I had not read the MTX symptoms thread--I know myself too well, and if that's what I get put on, I want to give it a fair shot and not look for things to happen to me.
Thanks again! :)
It won't be that uncommon for MTX to be the doctors first line of defense if things are bad for you right now....but I don't think it would be out of place for you to atleast mention some other DMARDS to try first and see what he thinks.
Also; my first marriage breaking up was a blessing although I didn't know it at the time. I've been remarried to a fantastic man for almost three years now and I'm really happy. He's my "Lovie".