It sadly isn't quite that simple. Its not so much that you develop what are called ADAs (anitdrug antibodies,) but rather you have in your system presence of certain proteins that are the base of specific ADAs not that the drug forms them. More simply put. They are already there.
For example a considerable part of the ADA found with humira is IgG4. About 38% of patients tested have IgG4. The number for whom Humira is not effective varies considerably based on the titrate (the amount of lgG4 present.) The bugger is about 6% with very high levels of both lgG4, the medication not only works but in the case of RA leads to "remission"
It appears that with in the next several years that we will be able to do a screening test base on the presence of these proteins and have a pretty good idea of where to start and what will work when prescribing these meds.
We will also shortly after that be able to vary slightly the composition of the proteins in biologics/immunizations to customize them to patients. We are already doing so with some cancer meds
Think about about these meds going into your body in a "bottle" with puzzle shaped spout that they come out of. ADA's are puzzle shaped protein floating around your body that if their shape and size happen to be the same as the med bottle spout, it will be plugged by the ADA and the med won't come out. Change the shape of the spout OR change the shape of the ADA and it will have no effect and the med will work fine. One of the real exciting things about the new Bio equivalents is they are all the same but different dramatically increasing the possibilities
Love the comparison TNT. I wasn't sure you were posting on the correct thread for a bit.
I do think I have a super strong immune system. So strong that's it's attacking me! It would be interesting to learn more about developing anti bodies to biologics. As there been a study? Have a link?
Soooo, it should be possible some time soon to screen for IgG4 and other proteins. And then those with high levels of IgG4 probably wouldn't be given Humira. Except that some with very high levels actually buck the trend and do extremely well on Humira. Flipping typical! I wouldn't want to be a rheumy trying to explain that to a patient.
That aside, customising meds to fit the patient would be a huge step forward. There's something quite mind-bending about trying one drug after another.
I would rather have a screening to simplify the treatment list. How nice would that be? I hope this is something that happens sooner then later. We could all feel less like guinea pigs :)
Interest is high trust me. Every failed treatment is considered to be 10 - 20 grand down a toilet That's why Great Britain is such a bugger. They are having trouble with their once an done policy (and rightly so) a
amielynn38 said:
I would rather have a screening to simplify the treatment list. How nice would that be? I hope this is something that happens sooner then later. We could all feel less like guinea pigs :)
The :Group for Research and Assessment of Psoriasis and PsoriaticArthritis (GRAPPA) working under the supervision of the BRA is supposed to have a new set of recommendations for NICE in early 2015 based on a new set of response criteria. If you look at page 10 of this:
and go to the section on what if TNFs fail, you will see the future and why so many "appeals" are being accepted. They will argue about it for most of 2015 and revise it in 2016. The data about subsequent trials is becoming clear as are the newer drugs that have included in the Phase3 trials failure with other Biologics
sybil said:
What kind of trouble might that be? Are NICE having a re-think? Or British consultants complaining? I keep thinking there must be protest of some sort from some quarter but thought all was quiet. Certainly we PsA Great Brits think the policy's a right bugger.
tntlamb said:
Interest is high trust me. Every failed treatment is considered to be 10 - 20 grand down a toilet That's why Great Britain is such a bugger. They are having trouble with their once an done policy (and rightly so) a
I have had the loading dose and I feel worse than when I started it. I am wondering if I should even do the next dose !
I'm so happy for those who got some traction out of it, though. tntlamb said:
With a med like Stelera that requires a loading dose, your first shot is really your third shot. If you in fact got six weeks from it that is amazing.
Now I suppose you are wondering about the first two shots? It may have been the medicine directly, it may not of been. There is an interesting effect of biologicals, that while their ultimate job is to bind to proteins and essentially change the dna your immune system is responding to they don't always work that way. There is something "new going on in the body and the body basically has a what the hell moment and the immune system doesn't know what the heck to do. so it does nothing. People have had it happen driving home from the doctors office only to discover 6 mos to year even more later the med "quit working" Recent research has pretty much determined they NEVER were working.
Rather the body jad a reverse Koebner effect. This happens a lot with PsA women talk about going into remission during pregnancy, an injury, sickness, major emotional event have all change the course of the event. IF we could bottle that effect, we'd really have something. We know it works we don't know why. Thats the trheory behind DMARD med, TENs units, spinal cones etc. Confuse the body.
This really doesn't apply to you amielyn in that yeah you had a an early response BUT yhere is every indication you are going to have a very successful relationship with this med. BRAVO
There is some studies in early phases where they are taking patients who had an early response to Biologicals, and later failed them that after a while and several others they go back and do a second trial and BOOM they work (are you reading Michael?)
Mimi, as I recall You have trouble with every med you start.... You have have of those super strong immune systems, sort of like a strong willed child. Once you get past the "will" its pretty cool until the next time. Hang in there.
I wouldn't give up on it just yet. I have read and talked to a few people who said they didn't get maximum benefit until the third 12 week shot, as in 32 weeks out. Hang in there and keep an eye on your symptoms. As I recall, I felt dizzy, had sweats, and was slightly jittery. Doc monitored it and said it was ok.
OK, thanks lamb and amie, I will try to persevere ! As far as the dizziness goes, I read an article a couple of weeks ago that talked about how PsA patients can have balance problems due to inflammation in the inner ear. Yikes.
This is very interesting. I guess I shouldn't say things like I did. The research is very complicated and idk enough about it nor have time to study it. Lamb, you have an encyclopedia of information to share--it's amazing--and appreciated. Puts me, for one, more at ease knowing they are figuring out the complexities of the disease to be able to treat it more accurately. Kind of excited for what the future might hold for all of us and our descendants!
tntlamb said:
It sadly isn't quite that simple. Its not so much that you develop what are called ADAs (anitdrug antibodies,) but rather you have in your system presence of certain proteins that are the base of specific ADAs not that the drug forms them. More simply put. They are already there.
For example a considerable part of the ADA found with humira is IgG4. About 38% of patients tested have IgG4. The number for whom Humira is not effective varies considerably based on the titrate (the amount of lgG4 present.) The bugger is about 6% with very high levels of both lgG4, the medication not only works but in the case of RA leads to "remission"
It appears that with in the next several years that we will be able to do a screening test base on the presence of these proteins and have a pretty good idea of where to start and what will work when prescribing these meds.
We will also shortly after that be able to vary slightly the composition of the proteins in biologics/immunizations to customize them to patients. We are already doing so with some cancer meds
Think about about these meds going into your body in a "bottle" with puzzle shaped spout that they come out of. ADA's are puzzle shaped protein floating around your body that if their shape and size happen to be the same as the med bottle spout, it will be plugged by the ADA and the med won't come out. Change the shape of the spout OR change the shape of the ADA and it will have no effect and the med will work fine. One of the real exciting things about the new Bio equivalents is they are all the same but different dramatically increasing the possibilities
Love the comparison TNT. I wasn't sure you were posting on the correct thread for a bit.
I do think I have a super strong immune system. So strong that's it's attacking me! It would be interesting to learn more about developing anti bodies to biologics. As there been a study? Have a link?
Just had my 4th injection 4 days ago and I am feeling great again! I just hope it lasts longer then 6 weeks. I am off the Imuran. I don't recommend it. It really messed up my stomach and intestinal tract. Here's to another, hopefully, 12 weeks!