Decisions...Yikes! | Arthritis Information

Hi Everone!...I am getting nervous!...I have a doctors appointment next Friday to start the biologic of my choice and I don't know for sure what to do. Humira, Enbrel , or remicade, what do I chose? My rheumy told me that it is totally my choice....I like the idea of Enbrel and its convenient but the idea of giving my self shots...stinks! I also like the idea of Remicade where I just go once a month and get it over with....I can watch a movie or nap or read a book...I read up with the benefits and side effects of all three and I am still not sure what to do.

Does anyone have an opinion?

Sure, how much of an opinion do you want???? LOL

With the info the doc gave my b/f about remicade and humira, my opinion has always been to try the remicade FIRST, because if you do humira first, and it fails, you can't really do remicade.

That's not a 100% truth, just the way it works in theory. I'd rather be safe than sorry though, if someone's giving you a choice in the matter, ya know?

I vote for Remicade

It really is totally your decision, but from one that failed both Humira, and Embrel, and is now on Remicade and is doing well I am of course going to vote for the Remicade. But, you may do well on the Humira or the Embrel.

Make sure you check with your insurance companies. They seem to have
the last word on "our" decisons.

I have done all three. Remicade was by far the easiest. DEFINITELY check with your insurance company before making a decision. My insurance company would only authorize the Remicade after I failed Enbrel and Humira. It's wrong, but that's the way it works with many companies.

Difficult decision to make. The IV infusion drugs are stronger than like humira or enbrel. Please make sure you check coverage on any of the biologics you choose. Please keep us updated on what you decide to do and how you do on it.

Katie...I have failed humira and most likely going to start remicade. Why did the doc say if you do humira first you can't really do the remicade? The progression is normally like enbrel or humira first then the IV infusion drugs if you fail those. Even the websites for like remicade or orencia say that so I am a little confused on this. Is it strictly for IBS that remicade wouldn't work if you have done the other biologics first? I have had 2 docs (pcp and rheumy) talk with me about the progression of RA meds and they both have said humira then remicade.

Well the way his doc explained it to us, Remicaide was made first. Whatever they based it off of, people have a tendency to develop an "immunity" (thats not REALLY what it is, just the only way to describe it) to the remicade. Humira was developed after, and is essentially an "improved" remicade. So if you do the humira first, and "fail" - as in you develop the "immunity" then the chances of the remicade working are slimmer. He didn't say that was a 100% thing, he just saw it enough that he always tries them in that order, just to be safe. And I know there's lots of folks on here who have done it the other way around without a problem. When your insurance has so much to say about what you're taking, sometimes you just don't have a choice.

The doc never said it as a hardcore-omg-you GOTTA do it that way-kinda thing, but just as his preference coming from his knowledge of the medications themselves. He got to be on a developing team for Humira, so I do wonder if he's a little off in his opinion....lol but it sorta makes sense!

Here is what I found out when I went crawling out on the web today.

Remicade is a chimeric (mouse/human dna) monoclonal antibody. Humira is a monoclonal (human only) antibody. Basically both meds (and all the biologics) end up doing the same exact thing in the body. Binding the TNFalpha (TNFa) cells. Remicade also the potential of actually lysing (killing) these cells.

The reason I found why we can change biologics when one fails even tho they end up doing the same thing in the body is that the pharmacology of each of the biologics is different. That is to say they are all made of different ingredients that get the job done. So if the ingredients in one biologic is not getting the job done...then you switch to a different biologic. I could not find anything stating that one biologic is better than another biologic. It is just going to depend on how the biologic reacts with your own personal body chemistry.

Please note that I did find where if you stop doing the remicade for a period of time then want to start it again your chances of an allergic reaction to it strongly increase. Just a little something something to keep in mind if you are feeling good and think you want to stop the infusions.

And that is Chemistry 101 for the day lol. Sheeeeeeesh you should have seen me looking up all the terminology for this stuff. I think my eyes were crossed when I got done lol. But it got the ole brain off of thinking about the pain for a bit lol.

Grandmaskittles you made me smile....Thanks for all the data...even if it didn't help me make a decision...LOL I have narrowed the choices down to Enbrel or Remicade, oh which one will work for me...probably the one I don't go with that is my luck...:-)

Glad I could make you smile!! We all need a little laughter in this mess that is RA.

Bottom line...you have to decide which med is right for you. What fits best with your lifestyle and your treatment goals?