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Rituximab vs abatacept-- After Enbrel fails

I (and my rheumatologist) suspect that Enbrel has stopped working for me. She suggested changing to rituximab or abatacept. Anyone here have experience with this change? Did you have good results?

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I don't have experience of changing from something else but have been on Abatacept for a couple of years now. I have it by monthly infusion. When I started I experienced a headache the following day but now I don't even get that. I do usually take it easy for the remainder of the day.

Good luck with whichever you choose.


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Hi Shareasmile,

I have also been taking Embrel for RA. I was relatively stable on this drug for six years. Then it stopped working for me.

My rheumatologist agreed to a change and wanted to replace Embrel with Rituximab. However after testing my blood for various things I came back as carrying the TB bug which had been laying dormant for years. I then went through the treatment to get rid of this, which in my case took six months. My Rheumatologist decided together with the Infectious diseases specialist that I be put on Abatacept instead of Rituximab. They tentatively let me start the Abatacept almost straight away. Goodness knows what the outcome would have been had I contracted full blown TB., during the six years i was on Embrel. Previously they did not test for anything prior to starting Embrel as it was not the protocol then.

I have been on Abatacept for eighteen months now and unfortunately it is not working for me. Having resisted having a general steroid injection during this time so as not to mask any inflammation/flare, a scan of my hands was arranged to prove I had active inflammation. I feel that this is a ' tick the box exercise ' to evidence that the Abatacept is not working. I am lucky in as much that my Rheumatologist does believe me when I tell him how unwell I have been. But he has to follow protocol and evidence his decision to change my medication. This all takes time, during which I and many others continue to suffer. Ho hum.

I had the much needed general steroid injection soon after my hand scan. Feeling good at the moment. Lordy, Lordy, thank heavens !

Currently I am waitin for an appointment with my Rheumatologist to authorise a change to Rituximab which was the preferred drug originally, until the TB germ was found.

These biological all work in a slightly different way, so here'shoping I do well on it.

This is where I am at the moment, so I'm unable to answer your question. Got there in the end πŸ˜ƒ

But like yourself I would be very interested if anyone else could share their experience of being treated with these same biologic drugs and how well they worked for them.

Here's hoping we both feel well in the near future and the replacement drugs suit us both.

Wishing you the very best.


Hi there.

I was on Humira (a Tnf inhibitor only similar to Embrel in this way)

My Rhumy wanted me to switch to Rituximab as I have high anti CCP. Rituximab has been shown to work best with RF+ and anti CCP+.

I asked if I could try Abatacept (Orencia) instead and have been doing very well on monthly infusions. I also inject 7.5mg of MTX. We are now moving the time between Orencia Infusions to every 6 weeks as I've been doing so well. I will say that it was very slow to work on me. I found great relief between 6 and 7 months. I have zero side effects from this combination.

I hope whatever you choose works well for you!



I started enbrel about five years ago but unfortunately it didn't help me at all. I then went onto Rituximab and it has made a big difference to me. I was in quite a state before I started it, i could hardly walk. Rituximab took around 4 months to work though and I had almost given up on it. The good thing about rituximab is you don't need it as often, i was 9 months between infusons and some people can go longer. I can't comment on abatacept as never had it. Good luck with whatever you decide on



I moved from enbrel, which didn't work at all, to abatacept. There was some discussion about rituximab but we decided against for now due to my rh factor being -ve and the fact I preferred the control of being able to inject at home. I was also a little concerned about having a drug in my system for a long time in case of side effects, but I guess at some time I will be trying it.

Abatacept weekly injections have worked well for me. Just over 2 years now.

Good luck with whatever you go for, hope it works well for you.


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