biological treatment

[Beata0102]

How long did it take you to receive biological treatment after diagnosis RA or Psoriatic arthritis and what qualifies you to receive biological treatment?

[Runrig01]

So to qualify for biologics, you must have tried and failed 2 dmards, one of which must be methotrexate. Then if you still have persistent active disease and a DAS score of >3.2 you can be put forward for biologics. It’s a slow process as you need a chest X-ray, blood tests including one for TB, which is sent away and takes a few weeks to get a result. If all your results are ok, they will apply for funding, as these meds cost the Trust £10-12,000 per patient. Most Trusts hold funding meetings weekly or fortnightly. Once that’s approved it’s sent of to the company chosen to delver and teach you injecting. So you can expect it to take 7-8 weeks from getting tests done. Hope this helps.

[MJSlide1958 in reply to Runrig01]

Hi Runrig01, You have much knowledge, wow! Do you happen to know what other dmards are better choice than Methotrexate because every week my daughter takes a 15mg MTX she feels sick, but still goes to work. She is on weekly Enbrel too which is fine with her, but needs the 15mg weekly methotrexate to help. Is there another dmard worth trying?

Thanks

[Runrig01 in reply to MJSlide1958]

Is she taking the MTX orally or by injection. If f oral it might be worth trying the injection, as some find they are less nauseous, as it bypasses the stomach. MTX is good at preventing you developing antibodies to the biologic. I take 25mg MTX with my benepali, which is a biosimilar of enbrel, and don’t get any side effects. Sulphasalazine is another dmard that may be worth considering, it’s impossible to say if she’d benefit, as we are all quite unique, but she should definitely contact her rheumatology team to discuss options if struggling.

[MJSlide1958 in reply to Runrig01]

Thanks so much and will ask her to mention to her Rheumy next appointment. She is on 15mg tablet Orion brand weekly with weekly Enbrel and 6 days a week folic acid.

[Cat-E in reply to MJSlide1958]

MTX gave me awful nausea and diarrhea, fortunately increasing the folic acid to 6 days seems to have helped, but my nurse did say that swapping to the injections can help with the sickness

[MJSlide1958 in reply to Cat-E]

thanks will talk to my daughter.

[MJSlide1958 in reply to Runrig01]

Also she has RA for 15 years now been on Enbrel since 2010 and over the last 2 years had to add MTX to keep it going. Shame about the sicky feeling.

[AgedCrone]

It differs with everyone. Diagnosis doesn’t automatically mean you will be prescribed a Biologic drug….quite a few people still manage on DMARDS (Disease modifying anti rheumatic drugs)for quite a long time.But you will probably get some idea after you have started a drug regime…speak to your rheumy, but realistically it can be quite a while……

Basically it will be your rheumatologist’s decision….. depending on your DAS (disease activity score) ,& the rules in place at your local health authority. Some require that you try 2 DMards, some 3, one to be Methotrexate, before your doctor can apply for funding for Biologics…..so don’t expect to get them tomorrow!

These days it is much easier …..with the introduction of Bio similars, the cost has come down & LHA’s are more able to fund them…..so those who qualify do get them much sooner these days.

[rmros]

About three years.

I was on hydroxychloroquine and sulfasalazine but still getting pain and inflammation. They wouldn't give me methotrexate because I wanted to get pregnant, and I couldn't have leflunomide or cyclosporin because of high blood pressure. Biologics were the only thing left, according to my rheumatologist.

They diagnosed me with psoriatic arthritis at the same time so I would qualify. I had originally been given a general diagnosis of inflammatory arthritis (with "probably psoriatic arthritis" added to my notes after a year of treatment).

[MJSlide1958 in reply to rmros]

Hi rmros,

Your advice would be so helpful. My daughter too at 32 years old now would like to have a baby one day. She is currently on weekly enbrel biologic and 15mg Methotrexate, she understands that she must come off of meds for 6 months to get pregnant, but what our the other alternatives whilst trying to get pregnant? your story would help very much so that she can get into a plan. It is not easy since lockdown to ask Rheumy all these questions, especially as she is at work full time. Many thanks

[Mostmoses]

For me it was about 14 months. Hydroxychloroquine side effects had me in hospital after just one week. Methotrexate side effects slowly escalated over a year but eventually also landed me in a hospital for 72 hours. The biologic (Cimzia) has some side effects too but so far (2 years) they are mild.

[ruth_p]

I was diagnosed in 1995 and didn’t start a biologic until 2008. It all depends on how you react to the dmards. Your RA could be well controlled with one, two or even triple therapy. So it is possible you might not need biologics at all.

[wilbertjellyfish]

Biologics aren't necessarily the golden bullet either, I've tried seven and still not under control with the arthritis. Thankfully they help most people when the dmards alone have not worked.

[MJSlide1958 in reply to wilbertjellyfish]

oh how are you feeling, have you got arthritis under control with dmards?

[Jackie1947]

Diagnosed 19 years ago. It wasn't until 5 years ago I was given an anti TNF and previously a biological that I became intolerant too. Before that I managed quite well on DMARDS and still take one of them. As it's been said you need to qualify for biologics. NICE had to approve the request. However this may have changed or not.

[MJSlide1958 in reply to Jackie1947]

How long did manage on the Dmards, was med MTX?

[Jackie1947 in reply to MJSlide1958]

Tried MTX and I tolerated it well for 18 months but it then started to cause intolerance. Taken off it. Tried most of the others on the market. Many years ago took Sulphazaline and still do. Two years ago when flare ups got worse I went onto Etanacept jabs. Took a while but my RA is in remission

[MJSlide1958 in reply to Jackie1947]

Very good results for you eventually, great!

[JLT1]

The period of time between my first diagnosis and going onto Biologics was about 40 years but ... that's because they hadn't yet been developed! I skipped injections of gold (one of the few "treatments" that were tried in those days) and was lucky enough to be a guinea pig for DMARDs, then MTX, then anti TNFs and, in the past ten years or so, biologics. Having a rheumy who's involved in cutting edge research helps!

All of them seemed to work for a couple of years and then lost their efficacy. The most success have had, to date, is with Biologics, but I was moved from fortnightly to monthly injections last year and now I find Week 3 is poor and Week 4 is agony. I need to go back to fortnightly injections again. My hospital is considering whether they will permit ie fund that.

I keep my arthritic fingers crossed that there's another new "miracle" treatment on the horizon. Forty years ago there was virtually nothing. Progress has been slow but steady.