Biologics | Arthritis Information

Can someone give me a short rundown on the differences between Remicade/Enbrel/Humira etc.?

This may be something I have to think about soon. I have an RD appt in 1.5 months and if the injectible MTX isn't working then we are going to consider biologics. But I am able to work full time although more and more joints are getting involved, and tonight it hurts to walk again. I want to have faith in the MTX but the pills did nada for me. I couldn't tell any difference.

I think we are going to do x-rays to see about damage and consult at Vandy before I would start anything (might try triple therapy first too) but I have been not focused on biologics b/c I didn't even want to think of having to go there. I have a tendency to get cases of strep that won't go away (but without high fever or really sore throat) and swollen lymph nodes, just low level stuff that I ignore but I have 1 and 3 year old so it is germ central in the winter.

Thanks for any info!

I don't know too much. My doctor said Enbrel & Humira are very alike and I could choose between them if I wanted a biologic. I think Enbrel is a shot 2 x per month and Humira is 1 x per month. Remicade is an IV infusion. I think you only have to do that every 3 months.For most people, insurance is the deciding factor. I started on Enbrel, then Humira, Remicade, and now Orencia. Each one worked for a bit-Enbrel probably the best. I went off it when I became pregnant and it wasn't effective afterwards.

Remicade is an IV that after the intial loading doses, is generally every 8 weeks. It takes 2 to 3 hours and I had to skip work to get it since the hours were to start at 10AM. I also needed it every 4 weeks.

Enbrel is twice a week or once a week depending.

Humira is supposed to be every other week but some people need it every week. The insurance plans really fight the every week so that is a fight twice a year. Humira has worked the best for me.

Each of them work differently and so come work better so different people. There is no way to tell in advance which will work best for you.

You might want to check with your insurance to see which will be cheapest.

Finally, They usually keep you on MTX and you will be adding the biological. The insurance will insist anyway. MTX is probably working, just not enough.

Good luckWhen I was taking Humira, it was a shot every two weeks. I stayed on it for 8 months and didn't notice much improvement. I went on enbrel and that is a shot every week. It has done wonders. The day after the first shot I woke up without any morning stiffness and I had energy. It's still working pretty well but tends to wear off a day or two before my next shot is due. I decided the humira first because it was cheaper money wise. Everyone is different. What works for one may or maynot work for you.

take care

MTX did nothing for me either. I have done 5 shots of enbrel and can already wee the swelling decreasing. MTX has a number of side effects and so do the biologics. If enbrel works the MTX will be decreased for me from 20 mg to 7.5.

I've been on Kineret, Enbrel, Remicade and now Humira. I can honestly say that the Enbrel has been the most effective so far it just seemed to start to fizzle out after about three years. The biggest difference, as pointed out previously, is the cost. Remicade will be the most expensive and is also IV administered. I'm pretty sure that Enbrel, Humira, and Remicade all belong in the class of biologics called TNF-inhibitors while Kineret works in Interleukin-1 receptor antagonist.

There is also no way to tell which one will be the best for you without trying it first. Enbrel worked great for me but it may not do a thing for you at all. In a sense it's like shooting craps. It's all a game of chance. Some people also get relief after only one treatment while it may take others months to feel better.

Another unfortunate side to these biologics is the increased risk of infection. I've noticed that I get more sinus infections now than before but that's the worst it's been for me.

Bob H.

www.arthritis.about.com

Go to biologic section, it will give you all the information about biologics. Lindy

Katie, I really feel for you having young kids and having to be on immunosuppressants. I started MTX after the birth of our 2nd DD and caught everything the girls had, twice as long, twice as bad. But it just was what it was with young children and them building their own immune systems. My husband never caught anything, except the evil eye when he'd say, "how come you're always sick." Thank goodness they know to warn me now, if they think they're catching something I go into a hand washing frenzy. Good Luck with your treatment.Thanks guys. I appreciate all the info. So I guess RD/insurance will choose. No real difference in exactly how immuno-suppressed you get from one to another, right?

My only thought at this point is that Enbrel seems to work best from what I've read here and overall, but, without giving up hope that they find a cure in the next 5 years, I keep thinking, should I hold off on Enbrel until I'm 40 if this thing isn't going away, and I'm just going to get worse. I guess a lot of that will depend on what the x-rays show, about whether or not the symptoms are doing a lot of damage.

I'm in pain and it sucks but not "I need pain killer" level pain (at least with my NSAIDS) (although I do complain a lot, but that bothers others more than me).

One of my worries is that my RD is so frustrated about treatments not working given that we caught it sort of early on that he is wanting to fix me. I want to be fixed but I also don't want to assume I'll go into remission and not need to be on biologics the rest of my life if I start them now. When this first started I could tell he thought he could get me in remission by the end of the summer but I think he's realized it's more stubborn than that.

He also made some reference about whether my 18 month old had finished his "live virus" vaccines so I may have to look into that.

I will look over all this so I'm ready for next RD appt...

MTX isn't the only dmard on the market. There are others that have proven successful. Also what dose of MTX are you taking? Your thinking of holding off till you're 40 isn't relevent to the disease process. You can be crippled by damage by the time your forty. As long as you have inflammation you'll have joint damage. That's the one given with RA. Once you incur damage it's not reversible. Your RD may be frustrated that he can't convince you to start a biologic when he/she realizes the longer you wait the more damage is being done. Yes, he wants to "fix" you, that's his job, and you might be the one patient that will achieve remission early on because you were diagnosed early in the disease process. You're lucky, many of us had to wait on diagnoses until we had damage.

If you're not taking max MXT then he may increase the dose and see how you respond or he'll add another dmard or suggest that you start a biologic. You don't need to wait till you see damage on an xray before you start a biologic because then it's too late. You might achieve remission but you have damage that can't be reversed. Lindy

LinB2008-08-17 10:30:40MTX has the advantage of boosting how well the TNF's work, which is why the insurance companies kinda make you.

Katie, I too think there will be a cure within the next 5 or 10 years and want to do anything to prevent damage until that day. I have damage and I know there is no fixing the damage so prevention is the name of the game.Yeah I might be willing to try other DMARDs first. ALthough I know my mom has issues with sulfa drugs.

He is hesitant about biologics too--almost undecided, so I can tell I will be involved with the decision. My RA is bad, but only in one joint. It is mild in other joints (so far). So I think he hates to do that to me...but it is my right hand.

I am new to Enbrel myself KatyG..but the 3 weeks I have been on it is has made a noticeable difference with me ..I don't wake up stiff in the mornings anymore and get a much better nights sleep ....I do an injection once a week ..so far ..so good..like you I had dire reservations regarding biologics but with joint deterioration getting worse in my hands (that was the main reason for starting not pain) I had to try something else and went with Enbrel as my RA doc suggested ...To sit by and do nothing I thought was foolish ...I have a problem with RA and must do what I can like so many on this board does....

Hope you find the right solution for you needs

Good Luck

Russ

Katie,

I was dx early, started on mtx, increasing dosage over a 4 month period, and adding Enbrel at that point since there was still inflammation, minimal, but it was there. It's now been 1 year on Enbrel and mtx combined and I've only had one appt where there was noticeable inflammation. I'm not as tired as in the past either. I remember my RD checking my finger joints early on and she would ask me if they hurt and my response was "not too bad" and her response was that they shouldn't hurt at all and if it was, that means damage can be occuring. If you still have inflammation, even it it's mild that is not good. Don't wait too long - as others with more experience have said - once the damage is done, it's done.

I work fulltime also and I don't think I'd still be able to do so without my treatment combination. Some days I wished I didn't work because I think it causes more fatigue and achiness and a more relaxed pace would be wonderful, but for now I need to keep working. There will time in the future to cut back to p/t or quit, for now I'll be thankful that the treatment plan allows me to keep working.

It's a tough decision and one not taken lightly, but don't base it on fear of side effects of long-term use. We can't predict the future, so best to take care of the present.