Possible Biologics

[Kati66]

Hi all,

When I had to speak to the nurse before Christmas as my symptoms had escalated, she mentioned trying a biologic. I’m currently on Hydroxychloroquine and leflunomide but my ESR and CRP are now raised. She arranged for my to have a steroid jab to get me through Christmas and I’m going in to see her next Monday.

My question is, can you be on DMARDS and Biologics at the same time? I have got on well with the Hydrox. and and Lef. so didn’t want to come off and start all over again! Do you know which biologic is normally used first? Just as I got my head around DMARDS I’ve got a whole new range of meds to understand 😮😮

Many thanks

Kati

[Runrig01]

Yes you can be on both dmards and biologics. I take methotrexate as well as benepali. Most rheumatologists use a tnf inhibitor as the first biologic, although it can differ if you have other conditions like inflammatory bowel disease. There are many names of these meds, as there are now biosimilars, which is what your likely to be offered. They behave much the same as the original drug, but a much better cost. You will need a chest X-ray, and bloods to check for TB before starting. It’s usually 7-8 weeks after, these initial tests, to you starting these meds. This is because the tb blood test takes a few weeks, then they have to apply for funding. It usually takes 3-6 months to see a good response

[Kati66 in reply to Runrig01]

Thanks for the reply, I didn’t realise you had to have funding approved for the Biologics. I guess she will explain the process when I see her next week.

[Runrig01 in reply to Kati66]

Yes, they cost around £8-10,000 a year, between the drug, training and delivery. So there is strict criteria. You also need a Das score >3.2. Your rheumatologist will explain it all 🤗

[tyncwmmarchhywel in reply to Runrig01]

hi , I think you are the lady who knows about adrenals// how do these tests works without having to go to your g.p. and practical beg, or can you have it done private

[Runrig01 in reply to tyncwmmarchhywel]

So there are companies like medicheck that you can send finger prick samples to, or some have nurses in places like Superdrug that can take a venous sample. It needs to be taken between 8-9am. You need to withhold steroids for 24hrs, but can take as soon as sample is taken. You shouldn’t get resistance from your gp, it’s a cheap test and lets them know your HPA axis is recovering. You need to be on 5mg prednisolone or less, any higher and your result will be zero, as the body recognises you have enough cortisol from the steroids when your on higher than 5mg. You could also see an endocrinologist privately, but that’s costly, I would use a company to get initial result if gp refuses. Do you have symptoms that make you suspect adrenal insufficiency? 🤗

[tyncwmmarchhywel in reply to Runrig01]

Thank you, fatigue but have been on lOmg. steroid for months now. Good to know all this info from you, must plod on. Take care.

[AgedCrone]

Your rheumatologist, together with the other specialists who are looking after you will use his/her experience to decide which type of new drug will suit you first….there is no fixed rule….we all get prescribed for our own particular need.

I hope you get something that helps you very soon.,

[Kati66 in reply to AgedCrone]

Thank you 👍🏻

[helenlw7]

Yes you can be on a biologic and a DMARD. I’ve been on methotrexate since 2010, and 3 different biologics alongside the mtx. I started with etaneracept, which worked well for about 10 years, then Adalimumab, which didn’t work, and I’m now on Cimzia, which is working well

[Kati66 in reply to helenlw7]

Thank you for the reply, it’s good you have found one that works well

[Beata0102]

Hi Kati66.

I have psoriatic arthritis and now I will also start biological treatment. I will be taking Adalimumab together with leflunomide and I am currently waiting for the biological injections to be delivered but it is a very long process for me the doctor decided in July of last year that I would start biological and I had to have a lot of tests before and then in November I had another visit with the nurse and she completed all the results and sent it and I am still waiting for the biological injections to be delivered

[Kati66 in reply to Beata0102]

My husband has psoriatic arthritis as well. His dermatologist is thinking of trying him on a biologic now too. He’s been on Metho for about 20 years now. Hope your injections come soon

[Beata0102 in reply to Kati66]

Metrotexate didn't help me at all with psoriasis but then I was on cyclosporine and it cured my whole skin in one week but nothing helps me with psoriatic arthritis I was on metrotexate, Sulfasalazine, leflunomide and cyclosporine and that's why the doctor decided that I'm going to biological treatment and I hope it will help because for a year I've only been able to move with a crutch

[K3-2]

Hi Kati66I am on Hydroxychloroquine and Leflunomide too and last September my Rheumatologist added Benapali injections. So far it's helping and the injection pens are easy to use.

Regards x

[Kati66 in reply to K3-2]

That’s great to hear 😁😁

[WilfDog]

Hi Kati66

Like others have said, particularly Runrig01, who explained it well, you can be on biologics and DMARDS.

You'll now likely be offered biosimilars due to the cost, but it depends on which one as to your particular symptoms. Some can't be given due to having uveitis for instance and which IA you have.

I was given etanercept in 2008 as it was known to work particularly well for JIA patients, alongside methotrexate, but I eventually had to come off the DMARD due to contracting neutropenia. In 2021 I tried adalimumab, a biosimilar, as it was found I also had AS, however I had sone reactions and I returned to etanercept as I had little or no side effects with it. I take it with prednisolone, but because I've been on pred a long time coming off it could cause adrenal insufficiency problems. I also take complementary potent supplements since 2017 and this combination seems to be keeping me steady at the moment.

Biologics made a big difference to my life in 2008, as I was in constant flare, so hopefully they will do the same for you and give you some stability.

Good luck xx

[Kati66 in reply to WilfDog]

That’s very reassuring to hear

[tyncwmmarchhywel in reply to WilfDog]

Can you illabarate on complamentary please, spelling afull sorry.

[WilfDog in reply to tyncwmmarchhywel]

Hi tyncwmmarchhywel

Complementary for me means taking Doterra's Lifelong Vitality Supplements (LLV), one of their Digestive supplements, and using their Certified Pure Therapeutic Grade (CPTG) essential oils for infections and sleep and for emotional support.

It also includes mindfulness and in addition to my exercise programme I practice Qigong, a form of Tai Chi.

This is the link to the LLV supplements I take

media.doterra.com/sg-otg/en...

media.doterra.com/us/en/pip...

Happy to chat about them. xx

[Happy5]

Yes been on MTX over a decade and just been started ( 2 doses) on biologics. Arm yourself with all you questions for when you see the nurse. So far so good in my case.

[smilelines]

coscentyx plus leflunimide for me. I read on a thread, just tonight, that they like to keep you on a dmard with the biologic as the demand prevents your body from forming antibodies against the biologic. I don't know if this is true but plan to ask my rhuemologist next visit. I have psoriatic-like- arthritis. Hope this info helps.

[Kati66 in reply to smilelines]

Thank you, I’m seeing the rheumatologist later today so will ask him.