I feel ambivalent about it. In late February, at about week 15, I seemed to be getting some tiny bit of relief from it, but since the first week of March I have felt very fatigued and still have a significant amount of pain.
I did have a few good days thanks to a prednisone burst. If only I could find a treatment that would make me feel even HALF as great as 20mg of daily prednisone !
Doc mentioned Stelara and Simponi Aria as possible alternatives. He didn't mention the new pill that was just approved, Apremilast (Otezla). Maybe he doesn't like that drug? I should have asked about it.
He wants to see if I get worse without the Humira, or if I stay the same. He feels that the risks of the drug cannot be justified without significant sustained improvements in my symptoms and I have to agree that even though I have had a handful of decent days, the risks seem hardly worth it.
I will stay on methotrexate and 5mg prednisone per day for now.
I'm resting from the gym until next week. I think I will try the water class and give my wonky knee a break from the bike.
The good news is that you still have quite a few options available. It sounds like you've given this a good try. If you're only getting minimal impact from it, it sounds like it is time to move on.
I wonder what really happens in your body when you can't take a biologic but you do use methotrexate and low dose prednisone. I'm hoping I won't get worse and can at least maintain until I find an effective medication to ease my symptoms and prevent further damage. What happens to people who cant use biologics because they don't work for them or they stop working. My Hx is
Remicaide: discontinued for possible allergic reaction
The good news, Mimi, is that there are now many different biologic choices, with more available every year. The bad news (which you already knew) is that each one takes time to try. The dreaded Gap again.
After your song list for Woe is Knee, I’m now humming “Breakin’ Up is Hard to Do”. Oh, by the way, you missed out “As Long as He Knees Me”.
Gotta laugh … if you don’t laugh, you’ll cry. I’m sorry this is happening to you, really I am.
"I wonder what really happens in your body when you can't take a biologic but you do use methotrexate and low dose prednisone. I'm hoping I won't get worse and can at least maintain until I find an effective medication to ease my symptoms and prevent further damage."
From what my current rheumy says, there is good evidence that long-term use of a biologic does make a large difference in slowing the progression of the disease. Prednisone absolutely does not slow damage, but it makes life more tolerable in the meantime. Huge benefit/risk tradeoff. Methotrexate helps with symptoms, but is nowhere near as effective as the biologics at slowing damage.
There are several other biologics, as you know. I'm a little surprised Enbrel isn't on your list- that's often the first or second one to try. (I'm just starting my third, Orencia, having had unacceptable side effects with Humira & Enbrel.) I hope the next one you "date" gets down on one knee and offers you the ring!
I don't know if this is true, but doc thinks that my response to Enbrel would be similar to Humira. He started me off with Remicade, which he refers as the "biggest gun we have against stubborn PsA.". That must be based on his own clinical observations.
See what he recommends. A lot of PsA folks seem to have had good results with Stelara. My rheumy assures me that there are several new drugs in the pipeline, too. Of course, if you're in the US, your insurance company gets a voice in it, too.
My rheumy told me that while Enbrel and Humira are in the same category they work somewhat differently. I can attest to Enbrel working much more quickly than Humira. But, like your current experience with Humira, the party was over all too soon.
Each person responds to each biologic differently. Until we have a test to narrow it down, it's a matter of trial and error. I find it disturbing that your doc is just leaving you on MTX and Pred. and not going on to the next biologic immediately. Enbrel should definitely be on your list!
There are lots of meds. Here are some I have tried:
Enbrel, Humira, Remicade, Rituxan, Simponi, Cimzia, Stelara, am currently on Orencia, Xeljanz (the JAK-inhibitor, oral). I'm sure I'm missing another one or two.
Your doc probably has lots of personal observations on how Humia and Enbrel work similarly in people, although their mode of action is actually quite different - And it can be really noticeable for some people, so it might be worth a try eventually if you and your doc agree.
Marietta, I think you have to wait a little while for one biologic to leave your system before you switch to another. I don't think he is ruling out biologics altogether, we are just waiting 4 weeks before we make a new game plan. During that time, I plan to do lots of reading.
For what it is worth, I just failed or ended Humira, my third biologic. Humira just stopped working for me. I started Cimzia immediately, no break between. You doc seems to want a clean break to assess. I wish you luck with your next course of treatment, whatever it may be ;)
I've always gone straight from one to another, to avoid a flare catching hold.
mimiB said:
Marietta, I think you have to wait a little while for one biologic to leave your system before you switch to another. I don't think he is ruling out biologics altogether, we are just waiting 4 weeks before we make a new game plan. During that time, I plan to do lots of reading.