Failed on Remicade, Humira and Embrel, what next? | Arthritis Information


Hi all:  I have been through all the DMARDS and many of the biologics and now am wondering what is next.  Has anyone been here and if so what did you do next?  I am thinking of Orencia and wonder if others have used this and if so any luck?  I am also on Celebrex, mtx, and 4 mg of Medrol.  I went off the medrol for 16 painful days and had to go back on after I began to flare really bad.   Any help would be appreciated

you have the option of switching out the MTX for arava or even adding arava if your liver function numbers are stable.  As for the biologics you have orencia, rituxan, simponi are still out there for you to try.  You also have some of the older immune response drugs such as cellcept, cytoxin or cyclosporine.  You also have the option of trying minocycline. 
So don't give up yet you still have options its just a matter of finding the right med
bumpThere are the drugs Buckeye mentioned, and there is also "Actemra."  It is in its final clinical trial, a few members on the Arthritis Foundation website are on it and seeing some positive results.  It could be approved by the FDA next year.

So be hopeful, new drugs to treat RA come along.  Hang in there and take care.
Thanks so much for the suggestions.  I have tried most of the meds. suggested including arava and a few of the immune response meds. as well.  I am hopeful that Orencia or Simponi or one of the new ones in the hopper might work.  been on this road for 15 long years...Hi Nan, it is a pleasure to make your acquaintance. I am so sorry so many therapies have failed you. I have little to nothing to add to what others have said, I simply wanted to welcome you and wish you all the best with finding a therapy that leads to positive treatment of a horrendous disease, firm control of your symptoms, and then forward to remission.

I can absolutely empathize with not being able to reach adequate control of this disease and the physical devastation uncontrolled or inadequately controlled inflammation can bring in its wake.

Have you considered a drug trial or other more aggressive therapies that involve more than medications?

Best wishes for a speedy resolution. Shug
Can your rheumatologist up your MTX?Hello Nan, I too failed all other drugs,due to one thing or another. Its frustrating but there are other things you can try,orencia being one, I went another route and started Antibiotic therapy , its not for everyone but I have had success so I am happy. I wish you well in finding something to ease your pain and make your life better.
Lisa xx
I am open to other therapies should the next round fail.  so far, we have kept ahead of erosions by moving on quickly to new treatments when others seem to loose their effectiveness.  I had 5 wonderful years on Arava and then 5 great years on Humira, with some not so great ones in between.  Then I tried Enbrel, no go, and now a year on Remicade with a no go there as well.  I remain hopeful that we will find a new one that works.  He really does not want me on any higher dose of mtx because I had some lung issues on the higher dose and the 7.5 seems to be ok. I have really hated being on the Medrol because I lost 25 pounds and was back to a size 6 and feeling great and then when the meds. failed and I had to go back on the medrol I gained back 15 of it while still maintaining a 1000 calorie a day diet!!!! Soooo frustrating....did not want to stay on it but until we get this figured out i have no choice....I work full time and just cannot afford to not be able to function....i know it could be worse and many have more to complain about than me but some days the derpession and lonliness of this disease gets to be too much...i have a very supportive family but i just hate to complain so i tend to keep it in (don't we all?)  which just makes it worse I suppose.  this board may be a God's send for me and I thank you for the welcoming posts   NanNan we all have to vent and complain, the loneliness of RA is depressing as our friends who dont understand dwindle so please come on here and chat...its not always a calm place but lots to learn here.
take care
Nan, I know it can seem hopeless when you've failed a few drugs in a row but there are still options out there. Here's a few, I suggest you take each one and research each throughly:

Antibiotic Protocol
Rituxan - this is the 'big gun' biologic
Alternative, natural and holistic - things like massage, meditation and hydrotherapy have really helped me

I know how scary it can seem when nothing is working and you feel like you are running out of drugs to try but you will find your way through here to something that feels right for you again.

The lonliness and depression are part of the package here, it's important that you address those with you doctors. I have had two fabulous counselors help me through. one a pain management psychologist and another a family therapist who also worked with my daughter. Get yourself some support outside your family unit then the brunt of it won't rest of them and you will have a place to express your feelings without burdening them, which is vital.

Remember that this too shall pass. It always does. Take care.

Thanks for all the amazing suggestions and support!  Have any of you tried Rituxan?  Is that infused?   I do swim two times a week, and I bicycle and treadmill as well.  Just started a Zumba class and go when I am up to it.  I just feel better when I move and exercise both physically and even more importantly mentally!  Nan

Hi Nan,

I am on Rituxan and yes, it's infused. Every six months you have two 8 hour long infusions. Rituxan is considered the next step up from the TNF Biologics - Humira, Enbrel etc. Rituxan is the 'big gun' biologic.

With Rituxan, some RA patients have a massive response with the first round and some need to compound rounds on top of each other to get a good result. I am about to have Round 5. Each time I am getting a better response but it will probably take up to Round 6 or 7 to get my RA completely under control.

This drug has a very high success rate.

Excerise is always good for our joints and our emotions in particular. Keep it up if you can, it can be very helpful.

If you want more info on Rituxan from a patients point of view, just let me know.
Pfizer is conducting clinical trials and looking for subjects for a new JAK-3 inhibitor drug.  I'll be discussing it with my RD today. and refer to NCT00847613 if you're interested in more info to discuss with your doctor.
Good luck to you.