MTX, Enbrel, Humira | Arthritis Information

OK I have my choice per my doctor.

I can take the maximum dose MTX or add either of the two TNF Blockers.

Opinions please.

If you have taken MTX at a lower dose and then increased it did you find it caused even more fatigue and brain fog then you were already experiencing?

If you have taken both Enbrel & Humira

Was one sure click easier to operate then the other? The Humira pen looks bulky.

Did one sting or hurt more then the other?

Did you find you have more energy on a TNF blocker?

My doctor says if I don't like the TNF after 2 months I can stop it.

Has anyone done that? How is it done- will you flare if you just stop?

Thanks!

I have taken both Enbrel and Humira with max injection of mtx. Idk about the Enbrel pen, I took 2-25mg shots per week that I mixed because I was such a baby about the pre-mixed sting-burn-pain thing.

Idk about the frain bog thing... if I was in pain, that was so much worse that when I wasn't in pain, not such a big deal. I took my shots at night before I went to bed and that seemed to help.

The Humira pen in no big deal, really. The bulkyness of it makes it easier for my clutsy hands to get a hold of it. It stings too, but icing the area and allowing the pen to come to room temp. helps, so again, no prob.

Yes, I definately have more energy on TNF because my RA is under better control and I don't have to expend energy on a flare ( well, wanttobe I just barely started with enbrel so I can't offer much help there. I can't tell if I will have more energy yet because I am on on my third shot. I don't mind the premixed ready to inject syranges. If I ice the area down real well there isn't hardly any sting. Ive been dong MTX since being diagnosed and that zaps my energy everytime. However I am hopeful that the enbrel may help regain some if not all of my energy level.
Good luck with whatever you choose and hopefully it will work for you. Let us know how it goes.
Man this sucks wanttobe. Not to long ago you were doing great on your mtx, now all of this. On a selfish note it scares me. I'm in remission, but when I get my shoulder worked on, and I go off the mtx, this is what I have been fearing all along.

Have you been taking plaquinel as well?

No La I never took plaq. I had a long remission too. From Feb 2008-Oct 08. Oct was when my inflammation markers went out of remission and I started having increased pain. I had gotten down to 2 mgs of prednisone from 40 in February but was stuck there. Then when I had to go off the MTX in Dec. I flared. So maybe something was already up with me.
Hopefully you will do just fine being off MTX for your shoulder. How long did they say you had to be off?
Mom2-3- I think I would have to use the click pens. I didn't realize the enbrel syringes sting too. I heard preservatives make things sting and Humira doesn't have them...At least that's what I think I heard. Hmmm I see waddie says it stings...
Not for nothing - this RA is a drag
I don't know about Humira. I think Joonie has said in the past that it stings quite a bit. Enbrel stings, but icing the shot site and allowing the shot to warm makes it better. Well, I never took it straight from the fridge so I don't know how much a cold shot stings but they say bringing it to room temp lessens the sting. The pen is easy, you never see the needle. About 10 seconds of ouch, but not that bad. You know it's been worth it for me. Hope you find what works best for you.Wanttobe-the plan is 2 weeks before and 2 weeks after- for 2 different procedures...arghLinncn- I think I can handle 10 secs. Do you use the belly or the thigh.

La- Are they afraid for infection? Do you mean you have to do 2 before and 2 after 2 times or total?

I have to disappear for awhile tonight- Gotta beat the FAFSA deadline for my son- my portion is not filled in yet......
Thigh. They say belly is less pain, but I just can't bring myself to do it. Besides, it's only 10 seconds.

I am on 25 mg. MTX, I take the pills, but did try the injectable and didn't notice a benefit to the shots so stuck with the pills.....and had Humira (Pen) and that worked for a while, and then went to Enbrel (Pen) and then that stopped so now I'm on Orencia with the MTX.

Humira lasted longer than Enbrel did for me. I also liked the Humira Pen better than the

sure click with Enbrel. For me, neither one burned that bad as I left them out of the fridge for 20-30 min prior to using and I ran an icecube over the area on my stomach I was going to inject first. Sure there is some burning, less with Humira for me, but it really doesn't last that long. I figure if It helps you get some of your life back with less pain and fatique, a little burning is no big deal.

Good luck and I hope you find your miracle drug. Either one you choose will be fine, if it doesn't work, you'll be trying the other anyway.

Wanttobe-I have to go off a total of 4 weeks for each procedure-a complete total of 8 weeks, but the procedures should be separated by a couple of months.

Oh-I forgot to add that my husband was put in charge of all financial aid stuff-I did all of the applications...all 7I maxed out MTX before I started HUmira and I'd do so in a heart beat if I had to do it over again in a minute. Chances are high that even one more pill a week of MTX could buy you another 6 month....or longer. I wouldn't want to do Humira or enbrel unless you have to.

Humira stings pretty good I think....and the pens aren't much better. They shoot in so fast and you can't control the speed at all. Going in that fast hurts in my opinion.

You have little to lose if the increase in MTX doesn't work and you'll never know if you don't try. There's not much going back after you start one of the biologics I think. I think it's like skipping a step. Max out first in my opinion.

what is the max dose of Methotrexate? I just started methotrexate, I took 4 pills and will go up to 6 pills a week. So far I have had no side effects. I do not know what you should do, but I hope it all works out for you alright. I am curious how long you have been on methotrexate before you have had to add another drug to the cocktail...

Take care,

TinkI believe the max dose is 25mg or 10 pills. Is that right? That's what I'm on and I haven't noticed a huge difference in fatigue from 8 to 10pills. I always feel kinda hungover. Not bad but not great.
I've not been on a biologic, although my rd is talking about it, but I agree with Lovie. I think max the mtx first.The max of MTX is 10 pills @ 2.5 mg. ea.....25 mg. a week. The rheumie said that some people find injectable MTX more beneficial. He had me switch to that a couple of months ago, but I felt no different so I went back to pills.

With all the meds, what works for one doesn't for another. What gives someone side effects or "stings" with injectable meds doesn't effect someone else.

Good luck

Wow! Thanks for all the feedback. It's great to hear real life experiences. Of course we all know everything affects everyone differently so that comes into play with making decisions too but I found this to be really helpful.
My doctor says the max dose for pill form MTX is 20 mgs. or 8 2.5 mg pills. To use 25 mgs. I would need to go to the injectable. Not sure why.
I started with 3 pills and increased to 6 where I have been for 13 months. All in all I think I fared very well side effect wise. No side effects that made me think- wow this is not worth the pain relief I have achieved. Also I was in remission for a solid block of time.
When I left RD's office last night I pretty much was in the mind set that I would try to max out the MTX first. (Memory issues caused me to leave my new bloodwork and folic acid prescrip behind at the front desk...)
I'm going to continue to mull over it a bit- it's not like it's a life and death issue. Like my Dr. said- you came a long way from the day I first met you and your husband had to help you out of the chair. You go to work every day and function like a normal person. It's just been recently that we have come to expect remissions and almost pain free days for RA patients. It used to be that we just wanted to get them comfortable.
Thank you for the well wishes!
PS

Cross the FAFSA off my list!!!!
what is FAFSA?FAFSA is non RA related- it's a financial aid loan from the federal government.

See how doctors differ Sno- yours and other people's doctors are OK with 25 mgs. orally....
I was on 27.5 mg of MTX for many years. I know of some people who have done over 30..but generally oif you need that dose level of MTX you also need a boost with something else.

Even though I've done both humria and enbrel I was on both before the sureclicks so I don't have any input on that

I'd go with max mtx first and see if that helps. My RD would allow up to 20mg by pill, up to 25mg by injection. My fatigue was still bad at 25mg, but no different from 25 to a lesser dose. Eventually, I added enbrel and I feel that's what took care of the fatigue as my RA was finally controlled. I use sureclick in the thigh - stings a little, but it is only seconds.

Good luck with your decision.

I do remember that when I went from 20 mg orally to 25 mg orally, my insurance company had to speak with the doctor to be sure it was correct. It was.. 10 pills, I am fine with them. I swallow them all at night, after a big meal right before bed...no issues.

I forgot to say regarding injectables, that I only did it in the stomach as the nurse told me that place is the easiest. Once I got over the "holy crap i'm stabbing a needle into my stomach", it was easy.

Again, good luck

Usually 25mg is the max for RA treatment. They of course prescribe it in much higher doses to cancer patients....but my doctor said that once you reach 25mg and are no longer being helped by it it's time to add something else. Many folks add something else like plaqunil or sulfersalizine long before 25mg and get results from that. I was on MTX for about 5 years....every once in a while we would add a little more until finally it wasn't working as well with an increase; that's when we added Humira. I don't regret adding Humira; but (In my opinion) there's no need to rush it.

You've got a long time to deal with this monster. Don't skip steps. Work your way into the stronger (More expensive drugs) because you will more than like HAVE to do it at some point.....but use what works ok for now before skipping to something that might be your saving grace in the future.

It's really have to write into words but I've explained it like this before: It's like climbing a latter. Everything you take.....even the things that work well will eventually wear off or stop working. At that point you'll either need more of the same drug to get the same result or you'll have to have something stronger to get the same result.

Even on a biologic we still have pain. None of us are totally pain free. THere's no real magic bullet here. Many of us are getting the same results with a biologic that we had in our early days when a DMARD like sulfersalizine could control. The disease progresses and the medication progression has to follow. Don't expect to jump into something stronger and turn back into the old you. You'll only be disappointed and drive yourself crazy chasing something to make yourself well. It's not out there. You'll goal is to find a treatment that can control it and give you the best quailty of life possible.

It's a hard decision to make....but you have plenty of time to make it. You don't have to decide anything today. You can always say "Let's give it a few months and asses it again at the next appointment". I did that for an entire year before I finally agreed to move onto Humira. Once I had to have my husband's help to climb the stairs to bed at night I finally said "Ok; It's time." You just have to decide what your breaking point is.

wanttobe-Sorry, backtracking here...I think you should talk to your doc about adding plaquinel. I take 2 pills a day, 200mg each. Time and again you read about combo therapy, and for me I am pretty much pain free.the La may have an idea, wantto! maybe add plaq?

I wish it was an easier decision..

like we knew what would happen if we did this or that..

I have no discomfort w/ the enbrel shot.. nothing.. feel nothing.. no burn.. no prick.. none of that....... and it use to help..

I'm not sure it is anymore.. I'm hoping..but I am having more difficulties in the a.m. than before.......

WtB,

I take Enbrel pre-filled syringes. I didn't like the idea of a spring loaded sure click thing. It's probably because I give myself insulin shots 4 to 6 times a day so I feel more comfortable with the syringes. I only inject in my belly. I can't bring myself to inject in the thigh. I don't even use my thighs for insulin. I am doing really well on Enbrel. It has helped more than the MTX. Good Luck with your decision. HG

I switched back to the pre-filled Humira syringes myself. My husband gives me mine and we just felt more comfortable using those. You can control the rate of speed it goes inwith those; not the quick clicks. Those are much faster; but a lot easier if you do them alone I think.I used MTX injections, Enbrel pen, and Humira pen, in that order.

RD said MTX injections work better than pills, and avoid the liver (would love comments). I filled up the syringe to 60 - how does that compare to # of pills?

Enbrel pen hurt, even though I always iced first and waited a full 30 minutes. I think I only had a very small bruise once on Enbrel (4 months, weekly). Little did I know I'd love to go back to Enbrel later...

Now on Humira, I hate the pen. I miss the 2nd click telling me when it's done. I inject in the thigh (great - apparently the most painful!) so I can't see the window. With Humira, I ice until I'm numb, keep pen out for 30 min, and it still hurts more than Enbrel. And THE WORST - it hurts to put the gauze on afterwards (as bad as the shot, and for some reason have been getting way more blood) and the icepack. I've bruised every time on Humira - 8 shots - all with icing afterwards.

Neither biologic has worked yet, but I'd be happy to do either if they worked and I had no side effects. Good luck - I wish the both of those for you!

[QUOTE=wanttobeRAfree]FAFSA is non RA related- it's a financial aid loan from the federal government.

See how doctors differ Sno- yours and other people's doctors are OK with 25 mgs. orally....
[/QUOTE]

Thats right those were the dreaded forms I had to fill out online for the goverment for the childrens college...I knew I seen the FASFA thing before..

I do enbrel sureclick pen and max of MTX. I hate the MTX and it didn't do much for me. The enbrel made the difference.I have been going back and forth with myself. This RA is playing games with me. I have been having such a range of "well being" vs. not feeling well that I feel like I'm crazy. One minute I'm thinking maybe you are just too focused on every little ache and pain and the next minute I'm like ouch- this really should not be.
I was actually starting to tell myself- you don't need to increase or add anything. Give it a rest- do you read what people here experience on a daily basis? Buck up kiddo.
However- on 15 mgs of MTX and 10 mgs of prednisone daily- this morning I awoke with the painful wrists, hands that hurt just to lift the blankets off. I don't think that should be with that amount of meds. Plus the doctor says I can't stay on 10 mgs and I certainly can't taper off if it's not even helping.
I feel so frustrated. I also feel like a jerk for complaining of something so benign compared to people who are REALLY suffering. I hate RA.
[QUOTE=wanttobeRAfree]
I feel so frustrated. I also feel like a jerk for complaining of something so benign compared to people who are REALLY suffering. I hate RA.
[/QUOTE]

You are not alone with feeling frustrated. And you are not a jerk. Please try not to beat up on yourself, it is not your fault you are dealing with this chronic, crazy, painful disease.

Please try not to compare yourself with others, you could always find someone worse off , which does void the validation of your illness.

Tink

Oh by the way, I hate RA also.