Still struggling with the logic of DMARD's and Biologics ?

I meant to discuss this issue with Rheumy but was distracted by other issues. If DMARDs suppress your entire immune system and Biologics are meant to target a specific aspect of immune system how can they work together? Why take a Biologic if you continue to take MTX? How do you know which one is working? If MTX suppresses immune system how can Biologic work?

14 Replies

  • Good question, I think I am about to progress to biologic and would be very interested in the answer, sorry I am just adding to the query and not answering it!

  • DMARDs don't suppress your immune system. Some like hydroxy have virtually no affect on it, whereas MTX does have a small compromising effect. However no-one is exactly sure why they work as well as they do as they have not been able to pinpoint the exact thing they do.

    However, the biologics are very precise and each affect one specific chemical process in your cells. If you imagine a huge machine full of many, many moving parts that isn't functioning as well as it should, then MTX is like giving it a general spray of oil and a biologic is going in and adjusting one specific cog.

  • I really like that analogy of the machine and the cogs for dmards and biologics, thanks

  • I am aware of Rituxan and how it triggers cell death via CD20 receptor on B cells. Which is why it is a good choice with lymphoma but I loose the line of logic behind taking the two drugs together. I am doing it, of course, but with some hesitation.

    I am going to focus on PVN for the next while and hope for the best. No luck , so far but who knows what they will think of next lol 😂

  • It's combining overall mild suppression of all fast dividing cells in your body (mtx) with targeted supression of certain inflammation causing agents (biologics) I would imagine the effect would thus be broader, as research seem to have shown.

  • A dmard is taken with a biological to prevent your body building antibodies to the biological.

  • Thank you all for making it a little clearer. The good news is I no longer need to think about it, it is done for at least six months. I will continue the injections until Dec then reevaluate. For now will focus on distractions. I will do what I can to stay active and not think about the pain.

  • Good question. Many doctors believe methotrexate doesn't work and some research is backing that belief. But then again some doctors believe biologics work better if methotrexate is added to the regimen.

  • I worry that MTX will kill my bodies ability to self correct. It does not help that my inflammation only dropped when I stopped all drugs. It leaves me confused 🤷‍♀️ The fact remains that pain and erosion are not controlled and a concern. As my doctor said, not so long ago I would have been in a wheelchair or institution ! Maybe a bit dramatic but message received. I will comply for six months

  • Very interesting. Do you have any sources of the doctors who believe MTX doesn't work? No drug works for everyone but are they saying it doesn't work for anyone?

    I have seen a few clinical studies that have small but significant statistics that adding MTX to a Biologic (even in very small amounts) has better results. I haven't found any studies indicating that MTX helps stop the body from producing antibodies against the Biologic although my doctor believes it does.

  • No doctors tend to be optimistic. They do however recognize that a significant number of people such as myself, are drug resistant or have refractory RD. It is believed that a long delay in diagnoses and treatment is one cause but there are others. There are many interesting articles publish Rheumatology journals. They are very complex drugs and it is a challenging disease . My background is in Sociology so tend toward statistical analysis. I have read many blogs, journals and studies. I think what is lacking is stats. Perhaps that is key to a successful treatment. There are many differences but also many commonalities.

    Who knows, perhaps I can generate measurable hypothesis!

  • Thanks for the reply. I was actually curious if there were any sources to the claim that many doctors believe MTX doesn't work. I'd love to see those.

    The doctors that's I've worked with have all been pretty optimistic. They are definitely aware of the 15 to 20% of refractory patients (I'm so very sorry you fall into that group 😥) but they are also very clear that since the early 90's things have changed drastically for those diagnosed in no small part from the advent of new drugs, aggressive treatment strategies, treat to target, and so on, that they rarely, if ever tell a patient now that they will end up in a wheelchair.

    I can definitely appreciate the complexity of the drugs and the subgroups of people doctors are trying to treat but there have been lots of different clinical trials done with loads of data, however, it's still very difficult to say what works and why because the simple fact remains that drugs work for some people and don't work for others with no clear reason.

    I've been trying to make heads or tails of some simple commonalities, for instance, between anti CCP positive or those whose inflammatory markers never raise, or those who diet and lifestyle changes is enough to keep their RA quiet and so on. The only anecdotal discovery I've made with a very, very small population is that men tend to do better with diet change then woman.

    To be honest I'm not sure what holds the key to better treatment. I think they've done a pretty good job in the last 20 years and I'm staying hopeful that more will be revealed. The discovery of more biomarkers would be nice. But, hey, if you can eventually generate measurable hypotheses by all means go for it! Wouldn't that be nice!

  • I agree , the difference is I feel the key lies in prevention. Using genetics , environmental and lifestyle risks. The problem has always been the complex nature of autoimmune conditions. RD poses a greater challenge , perhaps because it groups too many people together ? There are more than 80 autoimmune diseases identified thus far but that does not preclude further differentiation.

    The new approach of targeted medicine seems promising. We are only starting to understand how genetics work together. The field of epigenetics , nutrition, technology are all making huge strides daily. Even areas like archeology , anthropology . In the last few years they have discovered 3 new hominids. An entirely new haplogroup, an Incan city not previously found and the star map which includes all monolithic sites. The discoveries are mind blowing. I am beginning to feel a little primitive rofl.

    I think I have been so busy working in the last fifteen years that I have been oblivious to the world around me. The silver lining is I now have time to simply Be.

  • Wow just seen these posts! I am glad there are people like you who question this stuff! I have given up trying to understand this damn disease. MTX worked for me initially but finally it stopped. Now on bio and pain is greatly improved. But with all the drugs I am on, including cancer drug, I feel I will never feel as well as I once did. But if I stop drugs will my RA flare up and will my cancer return? Its a no win situation and I guess the drugs are my best choice. Oh I was also told I would end up in a wheelchair if I didn't take MTX when I was first given it! Thanks for your interesting posts.

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