Antidrug antibodies from Humira: no association with clinical response to Medication

Nobody asked when I suggested MTX helped prevent what the drug antibodies DO. Its just assumed that they stop the med from working and that meds will fail in time because of it.... Guess what somebody decided to study the antibodies and guess what the learned they do? NOTHING or so it appears. There are broader and a number of other studies that indicate the same is true with other Bios

http://arthritis-research.com/content/16/4/R160

FWIW I asked a doc (PhD) up the Bitteroot that invented one of these BIOs (not one we use) why they quit working. His answer was pretty simple "I dunno." When he elaborated he said his belief was they never DID work. they only confused the immune system enough it didn't know what to do, so did nothing while it came up with a new strategy. For many patients he said that was enough to take advantage of the time for other things to work......... or provide a welcome respite. He also mentioned his greatest Fear was producing a medication the produced "Charleys" (If you have never watched that movie you should - its an ey opener and though provoker)

I'm very grateful that there are people asking these brilliant, seems-like-they'd-be-common-sense-but-aren't questions in research.

I heard something similar to the confused immune system remark from one of my providers when the Enbrel stopped working for me after only a few weeks of real efficacy. It makes a great deal of sense. I'm hoping the slow start to the Humira (despite being maintained on a small predi dose) means that any effect from it is a real effect and not just confusion. The whole thing is baffling to me, frankly.

Omg that's depressing.

Why? I would think its great news................. Gives us the opportunuity to return to drugs rather than writing them off............

Grandma J said:

Omg that's depressing.

I'd be more content to be on a biologic that works rather than just confusing my immune system temporarily and then becoming worthless. I don't care to take meds with major SEs and that cause liver damage.

Maybe I'm not understanding your message.

The real question is for those who come back to previous failed drug or something similar last more than 6 months before failure. If forums are a barometer, my guess is the success rate is rather low. If that is the case, TNFs in general are irrelevant for a lot of people.

You would have to assume the forums are an accurate Barometer for gauging the failure of TNFs over time.

Forums aren't an accurate Barometer for anything. MTX is a very relevant drug for people and if you overlay databases, TNFs are extremely relevant

So just to be oppostional. Seeing as there is no definitive test for most of these diseases...... How do we even know that after several failures of various types of Biologics, the the person with the failure actually HAS the disease being treated and not some variation of something else. Dr Reveille (the supoposed AS guru) and the Houston group have suggested as much. (They are basing the theory on expanded genome discoveries in AS.)

The fact is Grandmas J is that LOTS of medicines quit working over time as the immune system finds a way around them - Antibiotics, NSAIDs, Opiates, Prednisone, and host of others. We have simply learned that MTX prevents antipody formation and that its likley that antibodies may not be the cause of meds quitting being effective. Means nothing to me as I take MTX because it keeps my fingers moving.

Incidentally the frequent liver panels are no longer required for MTX as the risk to liver is not statistically higher than any other metabolized medicine. Kidneys are still closely monitored because people won't drink their dang water........... (also the cause of most SEs)


mataribot said:

The real question is for those who come back to previous failed drug or something similar last more than 6 months before failure. If forums are a barometer, my guess is the success rate is rather low. If that is the case, TNFs in general are irrelevant for a lot of people.

You are correct; forums are not an representative sample of the population. However, one doesn’t have to look far to get a more representative sample (hint the manufacturers themselves). The number is high. Biologics are not a test for disease, of that is the case I don’t have psoriasis. I failed two biologics for almost no reduction in my plaque. However, I am clinical remission thanks to Stelara. Topological steroids stop working and it took multiple 20 mg tapirs of prednisone just to thin out my psoriasis. I’m sure that is result of 9 years of use of topologicals.

I wouldn’t be shocked that there is more variants of disease than our current classification system can handle.

Thar she blows!!!!!

mataribot said:


........I wouldn't be shocked that there is more variants of disease than our current classification system can handle.

"We have simply learned that MTX prevents antipody formation and that its likley that antibodies may not be the cause of meds quitting being effective. Means nothing to me as I take MTX because it keeps my fingers moving."

Word.

Gotta agree with everything you guys just said. And some of your comments are getting close to convincing me that maybe MTX wouldn’t be such a bad idea.



rosen said:

"We have simply learned that MTX prevents antipody formation and that its likley that antibodies may not be the cause of meds quitting being effective. Means nothing to me as I take MTX because it keeps my fingers moving."

Word.

Psoriasis has many varieties too, including several different types of plaque. While PsA made need to be redefined, you going to get kickback because of cost.

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sybil said:

Just got back from Belgium. 4 trains, 2 taxis, two walks loaded like camels, one car ride. Cannot understand a damn word of this but look forward to getting my head round it.

Enbrel worked ok Psoriasis. Besides an occasional NSAID I took nothing else. Humira never worked. I went back to Enbrel for a quick stint before stelara. Got a little bit of clearance, but got that stupid headache back so moved on.

Interesting, Sybil. But I do think that if we have the typical markers, i.e., psoriasis, fingernail deformities, tendonitis, brain fog, fatigue, joint stiffness-it seems pretty certain it is PsA. Unfortunately, most of us have so many additional symptoms, that no matter what we take as far as biologics and DMARDS, etc., we still have pain. My rheumy explained that I have a lot of osteoarthritis, and Enbrel wouldn't eliminate that pain and the deformity from it.

Something else I've thought is that when we're fighting off a virus our immune system is working really hard. Maybe it "conquers" the biologic and stops it from working. I've been wondering that ever since I fought off the 5-week cold, because that's when I started having PsA symptoms again.

It is very complicated. I, too, would like an inflammatory arthritis that eventually goes away. My mom had polymyalgia in her 70s. She took MTX for a little while but couldn't tolerate it so switched to prednisone. Eventually her prednisone dose was reduced to a wee bit--I think she takes a few mg per day. We're planning her 90th birthday bash , which will be in February! She had a knee replacement 10 years ago, and has horrible osteoarthritis in her hands, but nothing stops her. She even had quite severe whiplash 2 years ago because someone rear-ended her, which has caused her terrible neck/shoulder pain. It got her down some days, but she's finally getting over that. She's quite amazing--and it certainly helps to NOT have an autoimmune disease!



sybil said:

There are two things sticking in my mind here. One is the possibility that a biologic that appears to work for a while might actually have been confusing the immune system long enough for other things to work. What might those 'other things' be? The usual range of other things seems limited: DMARDs (generally Mtx), steroids and painkillers. Or might 'other things' include the body's own self-regulating mechanisms? Can the body defeat PsA if the immune system behaves itself long enough?

Then there's the mind-boggling but doubtless very valid point that we might not have PsA at all, or that it has more variants than are recognised. I gather that RA patients are often told that Rheumatoid Arthritis is an umbrella term for lots of nasty bits and bobs but from a layperson's perspective it seems likely that as PsA itself used to be lumped in with RA, research into different types of PsA isn't much publicised if indeed it happens at all.

And then there's the 'none of the above' category. How many of us must have wondered at some point whether we have some little known or as yet un-named form of inflammatory arthritis? Then we get a diagnosis and kind of cling onto it given that it often takes so long to get to that point. The implications are quite something .... as some forms of inflammatory arthritis just go away eventually, I want one of them!