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Arthritis and Rheumatism

RA and Biologics

10/14/2009

Question:

Some of my friends and I have RA, and are on different types of biologics. I have found that well all have been on at least 2 different ones. They either stoped working, didn`t work at all or we had a bad reaction to them. It seem that if they work, they don`t work for a long time, maybe a couple of years. I know that for some people they work longer. Is this pattern typical in general? Are people going to go on a differnet medication every few years? What happens when you have tried them all and still have very active RA like I do? What trends have you seen?

Answer:

The medications known as biologics that are currently FDA-approved to treat Rheumatoid Arthritis (RA) are etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), certolizumab pegol (Cimzia), and golimumab (Simponi) [listed in chronologic order of FDA-approval]. A small percentage of people that receive these medications will develop antibodies to the specific drug that may neutralize its effect. This is one possible mechanism for people to experience a diminishing effect of their RA medication. However, typically the biologics produce a durable improvement of disease.

The disease modifying anti-rheumatic drugs (DMARDs), including biologics, improve symptoms in the majority of individuals with RA. However, the degree of response varies between person to person. Thus, even if someone with RA is receiving benefit from a medicine, their response may not be robust enough to cause disease remission.

Additionally, the perception of pain and stiffness can fluctuate for any given person. In your situation, you may still be responding to your medicines, but it is an incomplete response that leaves you vulnerable to fluctuating pain/stiffness symptoms. If you are having an inadequate response to all classes of FDA-approved biologics, your Rheumatologist may try to change your traditional oral DMARDs. For example, some institutions have the ability to check methotrexate levels within a person's body. If subtherapeutic levels are identified then the methotrexate dose or delivery can be changed. Furthermore, RA is an active area of research interest and many innovative medications are being evaluated.

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Response by:

Raymond  Hong, MD, MBA, FACR Raymond Hong, MD, MBA, FACR
Formerly, Assistant Professor of Medicine
School of Medicine
Case Western Reserve University