I don’t know the difference between the two types of drugs… Do they work the same?
This site explains really well… it’s written for RA but the difference between dmards (MTX) and biologics (enbrel) is explained.
Thank you Cynthia…
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One big difference is the cost, which is why your insurance may be a bit resistant to covering them. I’ve read that in the US a biologic can cost up to $3,000 a month. Truly scary.
@Seenie is correct. Biologic costs are ridiculous here, as I mentioned in another thread, and to get approved you have to jump through all sorts of hoops. A good rheum will lead you through those hoops, though it’s a slow process.
Insurance companies will not approve biologics as a first line of defense here, from what I’ve been able to ascertain, and I sure as heck can’t afford that out of pocket (not if I want to keep my house and car and keep eating, anyway).
True, but if you have private health insurance (like through your work) you can qualify for a prescription assistance plan which lowers your out of pocket expense to about $5 or $10.
BriansGirl, I get the “Enbrel Support”, which is the assistance Janeatiu mentioned…your doctor can provide info about it.
I’m worried at the moment because my insurance is suddenly asking why I didn’t take Sulfasalazine or MTX before I started Enbrel. My rheumie’s nurse called me about it today. I’ve been on Enbrel over 2.5 years now, and I explained to the nurse that I didn’t take any meds besides OTC pain meds for the 6 years of diagnosis of my PsA. This isn’t the same insurance I was on when I started Enbrel, so I’m really concerned that they will make me backtrack and try Sulfasalizine and MTX before they agree to renew my Enbrel!
Hi You sound just like me… It’s been six years for me too… How come you didn’t start on mtx first? My doctor only mentioned mtx… I want to ask her all these questions about why that first? I’ve had cancer and skin cancers and I’m just nervous about mtx…
Hey @BriansGirl,
The usual protocol in the US is anti-inflammatory meds, then DMARDS and if you fail at both of these then you might well qualify for biologic meds. Biologics are so expensive that they have a stepped drug protocol in place to see if patients might benefit from older medicines. And many do. Without going through this process most insurance companies will not cover the biologic meds.
Starting you on DMARDS (MTX) is a good first step.
Thank you… That’s what I thought…
It helped to have had moderate to severe plaque psoriasis for nearly 40 years (that I had used prescription cortisone creams for all those years).
IDK, when my rheumy wanted to put me on Sulfasalazine and told me he’d have to do labs frequently to watch my liver enzymes, I said no way. I’m very sensitive to meds–usually a very small dose of anything works for me. I have off and on pain in my liver and gall bladder, and I thought MTX would also just aggravate that. So I got lucky and bypassed those meds to go right on Enbrel.
I have had hepatitis and liver inflammation in the past so maybe I can discuss this with her… I have so many issues… Why cant I just do things naturally? lol This sucks…
I would definitely tell your doctor about the hepatitis and other liver issues. You don’t want to aggravate that by taking something that is known to be hard on your liver!
GrandmaJ is right: MTX is hard on your liver. When you’re put on it, you get liver tests frequently for the first while, and then periodically after that. At the first sign of a liver mutiny, they reconsider the whole mtx plan.
GrandmaJ was lucky to have insurance that would cover her for Enbrel without having failed DMARDs first. We hear of that from time to time. We also hear about people who have gone on a biologic right away and then at some time down the road there is a change of insurance. The new insurer looks at the record and says “Hey, Chickadee hasn’t tried DMARDs. Let’s deny her coverage for the biologic until she has tried and failed three DMARDs for three months each.” If that happens, you just have to hope that your rheumie is a slick operator.
Indeed, why can’t we just do things naturally? I doubt there is anyone who hasn’t had that thought. The truth is that there is no good scientific evidence that natural, holistic, anti-inflammatory eating, gluten free, cherry juice, dancing-naked-in-the-west-corner-of-your-garden-at-full-moon or anything like that, works. OK, I hear you saying “That’s because big pharma has a stranglehold on the medical establishment.” That’s right, yes they do, but there are some large medical establishments on the planet which would greatly benefit if they could support and recommend natural healing modalities. (The UK’s single-payer NHS is one.) The trouble is, to date there hasn’t been a natural method which has withstood the scrutiny of cold, hard scientific analysis. Conventional medicine, though, has.
What there has been is anecdotal evidence: people saying, “Hey, this worked for me and I’m healed!” OK, good for you! And if I try it, maybe I will be healed too. But then I think back to my right hip: I was under the care of a rheumatologist who was convinced that leflunomide was doing me enough good. During that twelve months, though, my right hip went from OK to “replace asap”. What if, a year ago, I had said, “Thanks, doc, I think I’ll just go with my green smoothie diet.” I’d always wonder whether I’d made a mistake.
As it was, that experience sent me hurtling in the direction of PsA super-specialists. They were horrified at the condition of my body, and put me on a biologic p.d.q. That was three years ago. And my immune system seems to have taken a break from trashing the joints I have left.
No, not me: until I see the cold hard numbers crunched for the so-called “natural” remedies, I will continue with my conventional therapy. Because joint destruction isn’t “natural” either.
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Thanks GJ… I will have a long talk with her… She doesn’t know all of my issues… I have only started going to her… My first and only rheumy told me to go on mtx right away and that was 6 years ago… I will let you know what happens… Thanks for your help…
Hi, BriansGirl
My doctor also pushed me on mtx. Like you, I have had skin cancer - a melanoma 8 years ago - but I didn’t know that skin cancer and mtx interacted. Good to know! (I have resisted mtx because it is contraindicated for pinot noir! 
– Three times my doctor has tried to get me on Otezla, but they want me to take mtx first. After going round and round, it looks like we’ll be talking Enbrel come this Friday.
Slow down there.
THE MTX Melanoma link is anecdotal science at best. As much as I hate to say this the link betwee PsA and Melanoma is almost the same (not statistically different, in fact the same numbers apply to Chia Seed. Yes MTX is metastasized in the liver as are most “natural supplements” The difference? medical science recognizes it and follows. FWIW tylenol is MORE toxic and the info for MTX and liver is largley based on its use (in the old days as a chemo therapy drug at roughly 1000X the dose.
I can’t do a thing about liking pinot noir its nice to know it all doesn’t go to waste as I once thought (obviously its not pinot noir in my avatar) BUT the reason for thaat avatar is because when I went on MTX I was told only one or two glasses of wine a day, so being compliant I bought a new wine glass.
I’m no fan of MTX, but I sure miss it when I don’t take it and I have been on Biologics for a good many years now.
Thanks for that perspective! – So much to learn, and only one body to learn it with.
which is better on the body Mtx, Arava, or sulfadize
Sulfasalazine is the gentlest med on the rest of the body, provided your body likes sulfa. You can get pregnant on this one and indeed drink alcohol.
Arava (leflunomide) stays in your body for up to 2 years afterwards and you can’t get pregnant on it or drink any alcohol. So if you have a problem with it, you need to get it flushed out.
Mxt is probably the best for psoriasis and PsA but can be very hard on your liver and your lungs and again no pregnancy permitted and limited only alcohol intake.
Mxt hated me so I never got going on it. I refused Leflunomide and Sulfasalazine worked really well for me for a short while.