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How Is It To Go From Dmard To A Biologic?

A myRAteam Member asked a question 💭
Bluff City, TN

ive been on methotrexate and it didnt work. after that i started arava it worked until i got off of it to have a baby now it doesnt

April 2, 2018
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A myRAteam Member

This is way longer than anyone may have wanted, but I've been on many Meds for RA. The new Biologic Meds don't always work perfectly but they gave me my life back. Frankly most side effects would be acceptable for me given that I'd be on disability if my RA was not being aggressively treated. But even so, I have had no significant side effects from any of the biologics I've been on except a bit of tingling when I was put on my first biologic drug... @ Rituxan infusions. They managed that tingling with @ Tylenol and IV Benedryl. I was next on @ Orencia for about 6 months, but it never really worked for me. @ Humira was my third biologic drug and it worked really well for a while. I had low to no disease activity after about a 1.5 months on @ Humira. But after about 12 months, it became less effective for me so they switched me to @ Xeljanz. That also worked really well( bonus no injections) and I had no major RA symptoms for a bit over a year and a half and then that also slowly stopped working. It seemed that for me after 1 to two years on a biologic drug, they stopped working. My RA doc says that's relatively common for those of us with severe RA. We go through trial and error, or declining effectiveness. Then he ran a test called VectraDA (which is actually many tests) about 3 years ago to identify which of the many RA biomarkers was worst. The test taken while on @ Xeljanz showed I was off the scale for IL-6 protiens. So he put me on a drug that is an anti-IL-6 medication-- a monthly @ Actemra infusion. Since then I have been feeling mostly great and there had been no drop off in effectiveness. Unfortunately my insurance stopped covering it on Jan 1 2018 so my Doc put me on Kevzara which is also an anti-IL-6 med. It took a month or so before the Kevzara was fully working, but it is now working it's magic too. I have continued @ methotrexate while on all my biologics meds. Injectable @ methotrexate works better for me than oral (and at a lower dosage-- 20 vs 25 mg) and I have fewer stomach upset/GERD issues. If your insurance covers injectable MTX (@ [[treatment:@Rasuvo:5a4be7c8ff295026e09dc65c]], is the name) and you can afford the copay, it is worth it for the reduced side effects. My doc said it helps to take a Benedryl and a couple of @ Tylenol for the first months on any new injectable meds...just keeps you from having any minor reactions as your body gets used to the new drugs. I also take Benedryl occassionally because after many years of weekly or biweekly injections, I now get contact dermatitis from regular bandaids.

April 2, 2018 (edited)
A myRAteam Member

@A myRAteam Member I don't mind long answers. Thank you for taking the time

April 2, 2018
A myRAteam Member

Another long post lol
Like you, I was on Arava which worked fine until I got off because the rheumy I had said it was ok being that I was in remission. When my RA came back full blast 4 years later Arava no longer worked by itself. She put me on Prednisone, and being a diabetic(controlled, by diet) this made my blood sugar /weight go kablooey! I started with a new rheumy who wanted desperately for me to start a biologic but I was too afraid. He stuck with me though and didn't push, but gently told me that my body would tell me when it couldn't take it anymore. It did; All my levels went crazy. Thankfully my liver didn't. So after doing thorough research and discussing it with ALL my doctors with his blessing lol (pulmonary, cardiologist, primary,) I started Humira, working with the nurse ambassador. I have very good and patient doctors and a great nurse ambassador. All understood my fear and never criticized me. Just gave me the facts, what side effects and the chances of dealing with them (especially cancer)of being on Humira verses being without any other help to get my inflammation markers down. It has been 8 months and I will tell you that, barring the fatigue for a few days after the shot, I feel so much better and can do so much more. I'm taking it day by day, but each day is getting better. I still take the leflunomide(Arava) but am off Prednisone and soon insulin. I hope everything works out well for you. 😊

September 17, 2018
A myRAteam Member

I’ve been on many combinations of DMARDs. Methotrexate pills, plaquenil, aziothiaprine, leflunomide, & Methotrexate injections and prednisone. I needed to fulfill a medication dosing protocol but after 10 -13 weeks on several that didn’t work well I was recommended to move to a biologic. I was a bit frightened of the unknown... Would this finally be the one that will work? Would I have any of the dreaded side effects? What about the expense? Which one of the many should I choose? Yikes! So many decisions!
After the recommendation that i move to biologic was approved, I finally decided to go with Enbrel’s (etaneracept) as they had been around the longest and had shown a good track record (of course their patent has now expired so you can get a bio-similar under the Erelzi name as well). I had some initial side effects like site rash and bruising at the injection site, but this was a game changer for me and gave me most of my life back! I was on Enbrel for 2 1/2 years when provincial health switched many of us over to Erelzi due to a lower dispensing cost. I was concerned at first but it was unfounded as the bio-similar Erelzi works for me just as well. I’ve been on Erelzi for over a year and it’s still working well.
As a biologic is not a stand alone treatment, I take leflunomide as a complement to Erelzi.
My rheumatologist explained that biologics bind with a specific protein which is present in the blood of RA sufferers.
Don’t be afraid of biologics as they are in many cases a very good step to take.
🌻🌻

August 8, 2020 (edited)
A myRAteam Member

That helped a lot. ❤

April 3, 2018

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