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To those of you who have taken multiple TNF-inhibitors

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Rheumatoid Arthritis
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Posted 2/21/2006 1:50 AM (GMT 0)
Does your response to one TNF-inhibitor predict your response to another  one?  I ask because I am apparently not responding very well to Humira, and I may be trying remicade next.  However, it is difficult to get approved for these drugs, and I'm wondering if it would even be worth exploring another TNF-inhibitor?

Thanks in advance,

Elcamino

Posted 2/23/2006 3:08 AM (GMT 0)

hey elcamino,

i did ok on Enbrel 2 years ago for about 6 months...then got worse.  stopped for a month.  decided i definitely do better ON A TNF than OFF ONE...so started Humira in august.  on it now every 4 days plus Imuran, trying to get a hold on thr RA and CD.  the RA is more the problem.

i would try another TNF, in my opinion.

my docs say give them a realistic expectation.  6 months.  so if not by May...i'll start Remicade if the RA still progresses.

new drugs are out!

what about an adjunct to Humira? like MTX?

some TNF work better in people than other people.

aren't we lucky huh?

what an ordeal!

i know how you feel.

erin

Posted 2/23/2006 8:33 PM (GMT 0)

Thanks for your reply Erin.  I guess I will try another TNF-inhibitor, as my insurance has already approved me for them.  What can I lose?  I have also read that methotrexate can increase the effectiveness of Humira.  I have resisted taking methotrexate, however, because I don't want to take birth control and close the very short window I have left for getting pregnant.

Thanks.

Elcamino

Posted 2/23/2006 8:57 PM (GMT 0)

hey elcamino,

i understand too with the fertility issues.  it's a tough call.  you know, now i'm not by any means endorsing the idea, but it's been shown that people go into autoimmune remissions while pregnant!  i was reading about a woman with tremdous RA and she got pregnant & went into a 10 year remission.

hope for us!  if anything.

even with the Imuran i'm on, my doc is like...."you know make sure you don't get pregnant while taking Humira & Imuran, so be careful...."  and i do know that with MTX even if you stop the MTX, you have to wait for it to kinda clear your system so it doesn't harm the fetus.

what decisions! geesh.

are you trying currently to get pregnant?  and soon?

i do agree and believe that a TNF plus another adjunct med helps each other work better.  but if you really want to conceive, it's time to do some serious planning.

a combo of meds can make a world of difference, but you seem like you have higher issues to think over first. 

would you consider switching to another TNF alone without the MTX?  and see what happens?  i forget, do you have RA? i could be wrong but i thought you have CD as well?

i feel like you're making a good decision with trying a new TNF...you never know!

i wish you THE BEST!  i wish things were easier too.

sincerely,

erin


Posted 2/24/2006 1:33 AM (GMT 0)

Hi Erin,

I am not seriously considering having more children.  I have 3.5 year twin daughters, and me and my husband have our hands full.  But if I were to take  methotrexate, I would have to close the window permanently to a pregnancy.  Methotrexate, at higher doses, is used to actually induce abortion, and will cause serious deformities in any kind of fetus.  My rheumatologist would not give it to me (nor would I take it) unless I documented that I was taking birth control.  He said that if I were to get pregnant on Humira, or ENbrel, or remicade, I would most likely have to stop taking the drugs, but I would not have to prevent conception to begin with.  Honestly, it's probably not good to get pregnant taking any of those drugs, but I've met several women who have gone through entire pregnancies on remicade--and their babies were beautiful and healthy.  I'm almost to the point, though, that I would consider adding methotrexate to the mix--but I need to think and pray about it a bit more.

I am RF positive, and was diagnosed with RA 3 years ago after my girls were born.  My rheumatologist now believes that I don't have RA (I may just carry a positive RF, and it's not meaningful).  It's only slightly positive, and it's never moved in the 3 years that I've been seeing this rheumy.  He feels it could be the arthritis that precedes IBD by several years, especially since my father has UC, and I previously had GI symptoms indicative of IBD, along with a colonoscopy that showed extensive ulceration.  The problem is I had a colonoscopy yesterday with a new GI doctor, and my colon was perfect.  No problems at all.  Either my medications are working on the GI symptoms very well and healed the ulcers (likely), my IBD went into remission, or I don't have IBD at all.  Only time will tell.... In the meantime, it's my hips, my shoulders, my neck, and more recently my knees that are giving me fits.  I find it very difficult to get moving in the morning now.  I really need to find a medication or cocktail of medications that prove to be the magic elixir.  I'm really tired of hurting.

Elcamino

Posted 2/24/2006 2:58 AM (GMT 0)

Hi ElCamino - I have not tried a 2nd TNF yet, but do know some who have. One person I know was on Enbrel for psoriatic arthritis and moved to Remicade and is much happier, though he got amazing results on the Enbrel. Another person had a strange allergic reaction to Humira, but she is doing quite well on Enbrel now. I believe both are taking methotrexate with their meds.

My arthritis was a problem before I had baby #2. When I got pregnant with him, it went completely in remission during the whole pregnancy (it was so awesome! However, my immune system went completely down the toilet.) - only to come back ten-fold the very night I had him almost 5 years ago. Needless to say, I haven't been the same since. sad

I will say - that if you can get some type of birth control (do non-hormonal options count?) on the methotrexate, there are meds out there the doc can give you to get mthx out of your system quickly so you can try to concieve (the meds are not for that purpose necessarily, but they do exist as they gave it to me when I was hospitalized and my liver enzymes were off the charts.) 

Good luck.**

Posted 2/24/2006 12:40 PM (GMT 0)

CaMama, I would hope that non-hormonal options for birth control would count.  I cannot take any of the hormone birth control pills.  Blood clots run in my family, and even though I've never personally had them, I've had more than one doctor tell me that I should never take birth control pills because of the increased risk of blood clots. 

I'm thinking of trying Enbrel, but I'll talk to my rheumy about methotrexate in combination with Humira as well.

Elcamino

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