Methotrexate versus biologics for RA

[TMAblue]

HiI've been taking methotrexate and now also hydroxychoroquine for about a year for RA. My medication needs increasing as only on a low dose and still having problems.

I have the option of increasing the methotrexate or trying biologics (adalimumab or etenercept). Unsure what to do. I worry about being immunocompromised and I think biologics make this worse?

Any advise please?

Thankyou.

[Runrig01]

Biologics aren’t as tough on your immune system, as they only target a specific cytokine, in this case tnf. It generally turns the dual down from the high levels of tnf you have, to the level most people run at. MTX impacts the whole immune system. It’s also not usually either or, I’m on both, and have less infections than before my meds, I’m also on life long steroids. The other advantage is MTX helps to prevent your body producing antibodies to the biologic. There are many many cytokines in the body, tnf is only 1 of them, and can give good results at reducing inflammation.

[TMAblue in reply to Runrig01]

Thankyou that is useful to know.

[AgedCrone]

If you look back on here..it seems there are far more people complaining about Mtx than any Biologics drug.

I have been on a Biologic since 2016 & it has been a life saver. …so if your rheumy recommends a Biologic…I’d take that advice if I were you!

[TMAblue in reply to AgedCrone]

Thank you, useful to have other people's experiences.

[AgedCrone]

You seem to have posted this question a few times.

If I were you I would only leave the same message once on this site, or the replies you get will be confusing.

[MadBunny]

I've been on a biologic since 2014 , taken in combination with mtx , and it's worked well for me. To use a cliche it's 'given me my life back. 'It doesn't seem to have made me more immunocompromised . I get colds, but no more than I did pre biologic.

[TMAblue in reply to MadBunny]

Thanks for the reply. Useful to know.

[Clare-NRAS Partner NRAS]

I suggest you take a look at the SMILE-RA module on Medicines (nras.org.uk/smile/) which will help explain a bit more about how the various medicines work. Both methotrexate and biologics work at 'dampening' down the immune response as it is the immune system being overactive and attacking the synovial membrane that is causing the RA . If they are suggesting an increase in mtx dosage you may wish to consider injectable instead of oral if you're still on oral mtx as this then bypasses the 'gut' and can potentially be more effective on the same or lower dose. Worth a conversation with your specialist nurse.

[TMAblue in reply to Clare-NRAS]

Thankyou. I will take a look at this. I already have methotrexate injections now as had bad side effects from the tablets.

[AgedCrone in reply to TMAblue]

Depending on the Biologic your rheumy advises for you….& obviously if your rheumy agrees you can take a Biologic without continuing Mtx…I have been in a Biologic since 2016 without Mtx.

Mtx had suited me very well..but just stopped working…so my Rheumy said if it isn’t working there is no point in continuing taking it. I haven’t had any infections.

[Jackie1947]

I've been on Benipali (Etanacept) for 2 years. Brilliant result and beats all the other meds I've tried. I now walk without any aids and it's given me back a much better life. I have long term RA

[TMAblue]

Thank you for replying. That sounds good. They've told me it could be that one or adalimumbab.

[ruth_p]

They usually keep you on mtx once on a biologic as it’s meant to stop your immune system from building up immunity to the biologic.

[TMAblue in reply to ruth_p]

Ah OK. Thankyou for the reply.

[Madmusiclover]

I wouldn’t (didn’t) hesitate to try a biologic. It didn’t work for me and I ended up on JAKs but it is a required route to get to those.

[TMAblue in reply to Madmusiclover]

Ok thanks.

[BoneyC]

I tried Humira but stopped as it caused frequent UTI's for which I was hospitalised. Also tried Rituximab but that did nothing for me. Instead, I've taken MTX for over 40 years and HCQ for 15 years.

[TMAblue in reply to BoneyC]

Thanks for your reply.

[Rubygirl08]

Hi, I'm only just starting my treatment journey with RA, so can't really help from that perspective BUT my daughter has chrohns and quickly went through meds that didn't work (long process like our treatments) and has now been on a biologic for several years. Without being dramatic, it really has let her lead a full mostly painfree life for the past 6 years.Give it a try? Best wishes x

[TMAblue in reply to Rubygirl08]

Thank you. Most people are saying the same. Good luck and hope you get a treatment that works well.

[CagneysMum]

I’ve been taking methotrexate and hydroxychloroquin for almost 6 years and added adalimumab into the mix 3-4 years ago. Adalimumab has made such an improvement for me that I’ve been able to stop hydroxychloroquin altogether and halve my methotrexate meds to 10mg. As others have said here, it gave me my life back and I now have fewer infections, colds etc than before RA.

[TMAblue in reply to CagneysMum]

Thanks for replying. Most people are recommending giving biologics a try. I have a phone appointment soon with a biologics nurse as I wanted to ask a few questions.

[Haz58]

I have been in all the DMARDS. All except Sulfasalazine didn't agree with me. I've been on Benepali biologic jabs since November and the difference it's made is amazing! I was very worried about going on it but so glad I did. I was offered both as you have been but opted for etanercept, can't remember why. If you've been offered biologic take it I say. I got COVID for the first time in February but it was very mild and to date I've had 1 bout of an infection , flu like, which needed antibiotics. I expected to get everything and anything that was going around.

[TMAblue in reply to Haz58]

Thank you for replying. That's helpful to know. I have a phone appointment booked with a biologics nurse so I can ask some more questions. I have high blood pressure so need to know if that would be affected.

[Haz58 in reply to TMAblue]

I have high blood pressure too. Have had for years. I take 2 25mg atenalol a day. My blood pressure with etanercept has been fine I check it a couple of times a week at home as I have other problems and meds too. I wish you well whatever you decide and me and everyone else is here. X

[TMAblue in reply to Haz58]

Thank you very much. That's good to hear I also check mine at home.

[Jack2316]

I would highly recommend the etanecept therapy. Been on it for a few weeks and I haven't had to substitute any painkillers at all throughout the week just to make it through the day. It lasts all week round so far.

[TMAblue in reply to Jack2316]

Thanks that's good to know.

[KittyJ]

personally I wouldn’t add on another drug to take if I was only on a low mtx dose, if you are tolerating mtx then upping the dose a bit might just be all you need and if high dose mtx doesn’t work then you still have the option of adding the biologic later on. But that’s just me, I don’t take any more meds than needed and that’s what I did when mtx started to fail. 🤞🏻 for you whatever choice you make. I’ve not had any more infections since being on a biologic than before I took it.

[TMAblue in reply to KittyJ]

Ok thanks. They did want me to be on a higher dise of methotrexate originally but I found it hard to tolerate until changed to injections. Not sure yet how it would be if it was increased now. It feels like starting all over again with another drug but I suppose may be worth it. I have a phone appointment booked with biologic nurse to find out more about it.

[fred42]

I would take the advice from your Rheumatologist but read about things to ask relevant questions.

[TMAblue in reply to fred42]

Thank you.