golimumab | Arthritis Information

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Hi all, this is my first post here. My dr is looking at having me go on golimumab. Have never heard of this drug before. Has anyone out there been on it or are on it? I am currently on Enbrel but does not seem to be doing anything!I'd sure be interested in this subject as well.  According to "http://www.hopkins-arthritis.org/arthritis-info/rheumatoid-arthritis/rheum_treat.html#new#new" the list of DMARDs includes:  "DMARDs include methotrexate, sulfasalazine, leflunomide (Arava®), etanercept (Enbrel®), infliximab (Remicade®), adalimumab (Humira®), abatacept (Orencia®), rituximab (Rituxan®), anakinra (Kineret®), antimalarials, gold salts, d-penicillamine, cyclosporin A, cyclophosphamide and azathioprine (Imuran)."

But I don't even see all of them listed here.  So how does the Dr. choose among them?  I guess some of these are Biologics.  I've never seen much information that shows how the Dr. chooses one over the other.  Does anybody know?

Roland
I have wondered that as well. How do they choose? or is it just a case of moving on to the next one? Starting to feel a bit like a guinea pig here! Golimumab is Simponi, and if you Google it, I am sure you will find lots of information.  Basically, it is a biological drug which you take via self-injection once a month.  I tried it and found it was easy to use and didn't burn like Enbrel did, plus I didn't have to take it as often.  Unfortunately, it didn't really give me any improvement.  Hopefully it will work for you, as trying med after med is a frustrating (but sometimes necessary) road.thanks innerglow, this my fith medication! to say it is frustrating is an understatement! sometimes I just want to give it up and accept I will be in pain forever![QUOTE=Ramen]But I don't even see all of them listed here.  So how does the Dr. choose among them?  I guess some of these are Biologics.  I've never seen much information that shows how the Dr. chooses one over the other.  Does anybody know?

Roland
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I'm by no means a pro on this but my general understanding is that a rheumatologist will start you on an NSAID (Motrin, Voltaren, Naproxyn, etc.) along with Prednisone if you're in bad shape and possibly a pill-based DMARD like Sulfasalazine.  Thereafter the "cocktail" will be tweaked depending on your progress or lack thereof.  Methotrexate will be added if there is no progress.  With most U.S. insurances, biologics are only added if Methotrexate fails or is not effective enough - I believe the TNF inhibitors are tried first (Enbrel, Humira, Simponi, Cimzia).  If you fail two more more TNF inhibitors then you move onto the big guns, infused bioligics - Orencia, Remicade, Actemra, or the big cannon, Rituxan.
 
Anyone who has a better understanding, please correct me!  Tara, from what I've read on here over the years, each rheumy seems to have their own preferred path of treatment.  I was already on an NSAID for fibro when mine started me on Enbrel and only added mtx after I asked about it (after reading about it on here).  I've never been on Humira, Remicade or Cimzia, but went from Enbrel to Orencia to Rituxan to Simponi to Actemra.  I think some insurances require step therapy as you mentioned, but mine did not (BC/BS PPO).
 
And Roland, I think in the future (who knows how far) they will have better predictors of which therapy will work for a particular biological makeup, but for right now, it's unfortunately just trial and error.
innerglow, How did you find Simponi? I am starting it very soon and wondering on the results/side effects?Simponi was really easy for me, I had no side effects and the injections didn't burn/hurt like Enbrel did.  Plus doing it only once a month was so much better than weekly.  Unfortunately the Simponi didn't really help me either, but hopefully it will be the one to work for you.
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