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I ran across a very interesting article about the “next” treatment options for RA patients who either fail to respond to TNF-inhibitor biologics (primary non-responsiveness) or the drug loses its effectiveness (secondary inefficacy where the body may develop antibodies to the drug). These are some of the most popular biologics on the market and include Remicade, Humira, Cimzia, Simponi, and Enbrel (which also includes a circulating receptor fusion protein — whatever that is). I personally have been through all of those except Remicade and also Orencia which is not a TNF receptor but rather affects the action of T-cells.

I’ve provided the link to the entire article below (which is a blogger’s trick to get you to read the entire blog post first), but here are some things that struck me about it:

  1. About one-third of patients will make a change from a TNF inhibitor drug within a year.
  2. If the reason for changing the TNF drug is because it isn’t working well for the patient (as opposed to toxicity or side effects), many clinicians would consider trying another anti-TNF agent. However, there is evidence (four to five studies) now show equal or better results for changing to a drug other than another anti-TNF agent.
  3. A study published in the Annals of the Rheumatic Diseases showed that rituximab (Rituxan) was significantly more effective than an alternative TNF inhibitor after a first failure.
  4. A different study published in the same journal showed similar results for abatacept (Orencia) at six months, but was not as effective as rituximab at 12 months.

Many of us have been through a gamut of treatment plans searching for something that works. There is always the early part when you’re wondering if the drug will “kick-in”. Sometimes it does but then (according to my experience) it will stop working as well or seemingly stop altogether. So having some hard evidence on what does and doesn’t work in these cases and what the criteria might be for selecting “what’s next” is encouraging. Note that Actemra and Kineret were also mentioned in the article, but without any specific results.

But what struck me the most is something that it seems we don’t hear that often — an interest in patient preferences. Specifically, the article pointed out that patient discussions need to include their preference for an infusion vs. injection and for monotherapy or multiple drugs.

Additionally, one of the physicians interviewed commented, “It’s also important to keep in mind the patient’s perspective. Their numbers might look good, and their joint exam might look good, but if they’re still having a great deal of fatigue and musculoskeletal pain secondary to their RA, that’s also an important integral part of the whole treatment.”

Wow. All of that great information AND caring what the patient prefers and how they feel instead of just how their numbers look. It doesn’t get much better than that.

The bad news? Well for people like me who have been on multiple biologics, the article says, “”But what gets extremely frustrating is patients who have already been on multiple biologics, TNFs, one or two non-TNFs. They have a very small chance of having a major clinical benefit with a further agent.”

We’ll see. There are new drugs and treatment ideas coming along and I haven’t been through the entire list of current drugs (yet!).

I hope whatever treatment plan you’re on is doing wonders. Here’s the link to the article. Thanks for checking in.  http://www.medpagetoday.com/Rheumatology/Arthritis/44257

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