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biological add on med. yes or no?

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Rheumatoid Arthritis
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Posted 12/20/2010 2:19 PM (GMT 0)

I'm new to this site --

After 12 weeks of methotrexate 15mg/week med for my RA, I'm doing much better. However, my blood test shows no recent improvement in joint inflammation, so my rheumatologist wants to add a biological (expensive) drug.  I've been taking up to two Tylenol 650 mg tabs per day if pain flares up (Mostly wrists, feet, collar bone, or upper neck) This seems to work.

I don't like what I read in most of the posts on these drugs. Seems like a big crap shoot to find real remission. As an alternative to the higher cost added med, I'm considering going into a Phase-II study of a new drug, SAR153191 where there are six groups - one is a placebo. If I don't see improvement I can opt out. Maybe going to 25 mg of MTX would be a better option for me now or after I see how the study works for me.

Ol' Roy

Posted 12/20/2010 3:28 PM (GMT 0)
I didn't feel really better until I went on 20mg/wk of MTX, 15 just wasn't quite enough. It's interesting how only 1-2 little pills can make such a difference, maybe 20 or 25 will work for you so do talk to your doctor about an MTX increase before biologics.
I plan to go on biologics only if I need to even though I know the ugly stuff. I am looking at my quality of life-not quanity. Let's hope it's awhile yet.
Others can talk about trials. I don't have any info there.

Best of luck.
Posted 12/20/2010 11:18 PM (GMT 0)
I tried a biologic and didn't find I got the result I was looking for so I stopped it. Didn't think the benefit outweighed the risks. However- that is just me. Everyone is different and it would hurt to try it and see. You can always go off if you don't feel terrific. All the best to you.
Posted 12/21/2010 2:03 AM (GMT 0)
I too had to go up to 20 mgs a week of MTX to make a true difference.
The decision to add a biologic should be made based on the potential for joint damage. I have had RA for 14 years now and have no joint damage-other than in one toe. My rhuemy and I are in agreement that biologics would be used only if my quality of life could not be maintained with the DMARDS I am on and an occassional medrol dose pack.

Someone newly diagnosed with aggressive disease should be quicker to go on biologics to prevent damage.
Posted 12/21/2010 5:09 AM (GMT 0)
I seem to need both biologics as well as the 20mg mtx. Adding the biologic to me changed my life. Its been the only true relief I've had. If the mtx isn't enough then I'd definately go for the biological. The percentage of people who have adverse reactions to them is very small.
You have to weigh up quality of life vs pain or permanent damage, I'd say its worth the risk.
I remember being scared when I started too but after several months of worsening pain and symptoms, I gave it a try. I couldn't believe how good I felt. What a miracle med they are. If the mtx doesn't work I'd definately try out a biological.
Best wishes, golitho
Posted 12/21/2010 12:21 PM (GMT 0)
Thanks for your input. I now feel I need more conversation with my rheumatologist before deciding.
Hope your Christmas is painless and merry!
Posted 1/6/2011 1:26 PM (GMT 0)
Based on feed-back from several on this site, I've increased my MTX from 15 to 20 which is a 67% increase. I'll give it about eight weeks and see how it works.

I"m also thinking that if I need more meds, I'd consider the Phase-3 study which just started for an oral add-on called fostamatinib. I understand it to be a new class. I like what I read so far.

 http://clinicaltrials.gov/ct2/show/study/NCT01197521?recr=open&cond=Auto-Immune+Disorders&cntry1=NA%3AUS&lup_s=01%2F04%2F2010&lup_d=360

Posted 1/6/2011 6:18 PM (GMT 0)
Have you tried plaquenil? I found that 20mg of MTX plus plaquenil really made a huge difference...at one time I was also on Enbrel (biologic) with the other two meds, and I have to say it was only then, that I felt almost my old self pre-RA. Sometimes it takes a combination of meds or an increase in one medication to see a difference.
Posted 1/6/2011 8:57 PM (GMT 0)
I take 20mg/week of MTX, which according to my nursing drug handbook is the maximum dose for arthritis - although I know some people take 25. I added Humira (a biologic) and it helped immensely for about 3 months, and then stopped working (as far as I can tell). I also added Plaquenil with no noticeable change.

If you can get insurance to pay for it (I had to fight with mine), I'd say give a biologic a trial of 6 months to a year. You never know, it might make a big difference for you, and I'd say it's worth a shot anyways.

Kathryn
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