As some of you may know I have been trying to understand why my consultant has deviated from standard NICE prescibing guidelines for RA and missed out Anti TNF and gone straight for Mabthira biologic treatment. Last night I stayed up really late searching the web. ( when my consultant mentioned Mabthira I thought it was an anti TNF.. Only became clearer last night)
In case you are interested or may ever find yourself in this situation.
I came across a media release by Roche 17 June 2010.
Experts at 2010 Europeans league against Rheumatism ( ELUR) annual congress highlighted to Rheumatologists " that targetted treatments in RA, through the testing of specific blood markers at the time of diagnosis ,could have a significant impact on treatment decisions, resulting in an improvement in patient quality of life."
OK good. So what are the bio Markers then?
Rheumatoid Factor RF and Anti -Cyclic citrullinated peptide ( anti CCP) two characteristic autoantibodies produced by over reactive B cells are found in apparently 80% of people with RA. In other word Sero Positive. Sorry if this is old hat to long suffering RA people but this realisation it is breaking ground to me. I think others have tried to explain it but sometimes we need things in bite sized peices or arent listening properly.
immmm. So I possibly have over reactive B cells???
" As selective B cell targetted therapy , Mabthira is the first and only targeted treatment options available for RA." Roche Media Release 17 June
Rituximab is actually a therapeutic antibody, which bind specifically to the CD20 molecule on the surface of B cells thereby putting these cells out of action.
This morning there was a message from my biologics nurse specialist. It went something along the lines of... the consultant does not want you on Enbrel he wants you on Mabthira. Ive booked you in for the 6/6/2011 and you will be recieving a letter.
So why has my consultant deviated from standard NICE protocol in my case?
Well I think he is trying his hardest to achieve a remmisssion for me to enable me to stay in work which at this stage is what I have asked him to help me with.
Assuming I am sero positive ( i must be to justify the risks of B cell depletion) what are my odds with Mabthira compared to someone who is sero negative?
According to the Issacs,J et al. Biomarkers Study presented at EULAR conference 2009" At week 48 seropositive patients were over 3x more likely to achieve a 70% improvement in symptoms (ARC70) compared to seronegative patients."
Im really afraid to take Mabthira. Why? because if there a medical event it always seems to happen to me. The rarer the more likely !!!
However there is nearly a decade of safety analyis and the evidence is that there is no increased risk with a different biologic ( such as an Anti TNF) following discontinuation with Mabthira.
So I have taken the decision unusually I suspect to treat my RA aggressively and to have some blind faith in my consultant to some extent.
I will write another blogg in 6 months time to report on my Remission status and quality of life and most importantly for me at the moment whether I am in work.
Wish me luck