On Wednesday, August 2, FDA advisors voted 12-1 against approving the promising new RA drug, sirukumab. In a field dominated by TNF-targeted biologics, this was a new anti-IL-6 drug. Actemra and the recently announced Kevzara are the only other two IL-6 drugs on the market. While the trials proved that the drug’s effectiveness is “robust”, the primary concern, as reported by Medpage Today, is the drug’s safety, although earlier reports also mention potential flaws in the trial design that could impact the trial’s reported results.
I have mixed emotions about this announcement. On one hand, I hate to have major setbacks for what appears to be a great new option for RA patients, on the other hand, I want our drugs to be as safe as possible and applaud the caution in withholding approval.
There was another discordant note in this news story, however, that took me aback. This was the soundbite from the one person who voted FOR approval of the drug — he was the “1” in the 12-1 vote. His name is James Katz, MD and he is the director of the rheumatology fellowship and training branch of the NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases in Bethesda, Md. According to MedPage, he said, “This drug doesn’t scare me any more than the other biologics. I’m scared of all the biologics.” And this is the guy who voted for approval???
Why does this bother me?
In a world of fake news and quotes taken out of context, I went in search of the full statement to see if he elaborated further. I was on a panel recently with another leading rheumatologist who stated, “RA is a serious disease and it takes serious treatments to combat it.” And let’s face it, serious drugs can be scary. I thought perhaps that Dr. Katz’s comment about biologics were along these lines.
But other than the mention in Medpage, I haven’t (yet) been able to find anything further on the comment. (I’m still looking so if you find it before I do, please let me know.)
My concern is the effect of these words can have on RA patients, particularly those who are contemplating a biologic for the first time. Yes, it’s true that biologics can have serious side effects. But it’s also true that thousands of thousands people use them on a daily basis without problem and are able to lead fuller, more productive lives by helping control the devastating effects of this disease. While treating RA is serious business, NOT treating RA is even more serious. Without treatment, RA can be debilitating and, once the damage is done, it cannot be reversed.
I personally am on a biologic and methotrexate and I am doing better than I have in a long while. But that’s not the right answer for everyone. I think treatment plans need to be personal, that they need to be decided upon by the patient and the doctor, and that the full mosaic of information needs to be considered when making that decision — not just a soundbite.
I hope the soundbites in your life today are happy news. Thanks for checking in.
All of us develop preferences for certain treatment options. Some people like infusions while others like the convenience of home injection. I’ve always been an auto-injector kind of girl, but I have friends that like the control that a traditional syringe gives them.
The first injection I ever gave myself was a blood thinner I had to inject daily for two weeks after my hip replacement surgery. I could barely feel the injection, but it was a standard syringe and I hated, hated, hated actually sticking the needle into my skin.
I’ve been on an off various treatments and while I prefer no needles at all, if I have to do an injection, I prefer the simple click of a button of an auto-injector. (Because I still hate sticking that needle in my skin.)
I’m now on a biologic and injected methotrexate and the MTX I use comes in a vial and I use a standard syringe. I’ve come to dread Sundays which is MTX day at my house. Then earlier this week, I learned about the Autoject 2. You basically take your standard syringe (filled with the appropriate medication), place it in the device and it works like an auto-injector. Zip. Injection is done with no pain and no drama. I started to do a video but here’s already a pretty good YouTube video showing how it works here: https://www.youtube.com/watch?v=fndalvwKF4s.
Apparently a lot of people use this for shots they give their kids and pets because it’s easier. I certainly found it easy to use and highly recommend it for anyone who struggles with traditional injections.
A couple of notes because finding detailed information on the product is a bit difficult. First, the Autoject 2 works with syringes that are 1 ml. or less — which works great with insulin and a lot of MTX dosages. I think there is a larger one for bigger syringes. Second, you have to be a bit careful. The auto-inject pens that I’ve used that come prefilled from pharmaceutical companies have a safety measure where the needle is retracted or covered after the injection is complete. That is not the case with this device. The tip of the needle still extends out until you remove the entire syringe.
I got mine through Amazon for about $33. It was essentially the same price I saw on Walmart and a couple of other mail order sites. Even though I only use it once a week, I definitely think it’s worth it and would certainly think so if I had to do an injection more often.
So, that’s my story and I’m sticking to it. (Get it? “Sticking” to it????)
Doing my happy dance now that I don’t have dread my MTX injection. I hope whatever you’re dreading (and we all dread something) turns out to have an easy solution as well. Thanks for checking in.
This is the final installment of ten things I’d like to go back and tell my newly diagnosed self about living with RA.
This series of things about what I’d like to go back and tell myself was inspired by a book called, Rules for Kids. It was a collection of 187 rules compiled by two girls who both had younger sisters with which to contend. I heard about it on a television news story. The news story didn’t cover all 187 rules, but it gave a few examples, and I was especially struck by #105 – Tie your shoes or you’ll fall down.
When you think about it, that’s pretty important advice — especially those of us with RA.
Read the rest of the article on RheumatoidArthritis.net: https://rheumatoidarthritis.net/living/no-10-tie-your-shoes/
It’s been one of those weeks and, being black and blue and sore, I’m glad other people aren’t scheduled to stick sharp objects in my poor veins for a while.
I’ve written before about how much of a needle-phobe I was when I was younger. When you have RA, you pretty much have to get over that. But occasionally, like this week, sometimes enough is enough.
I am pre-diabetic so I take a daily injection to help control my glucose levels. It’s a short, tiny, tiny needle and I don’t even feel it, so it’s no big deal.
On Sundays, I take two injections. In addition to my daily glucose shot, it’s also methotrexate day. I hate this one because even though I use a pretty fine (25 or 30 gauge needle), I have problems actually getting the needle inserted (more about this later).
Monday was my infusion day. There was a new infusion nurse. My doctor has changed the company that does the infusions. My old infusion nurse was great. I have tough veins but she figured out what worked and usually got the IV started on the first try and I seldom bruised afterward. The new nurse, even though I told her what had worked in the past, didn’t do as well. She hit a vein the first try but then it blew out when she irrigated it. So we tried a couple more times. Finally, her supervisor tried a smaller gauge needle and found a vein and (after 45 minutes of poking me with sharp objects) finally got my 30-minute infusion started.
I turned black and blue and every vein that is worth its salt has been poked and bruised but I had to get labs done. I waited a couple of days hoping my veins would heal up and headed to the lab. I love the lab. They’re great and they know me and immediately start reaching for the small butterfly needles when I come in. But when I went in I told them I wanted them to look first and if they wanted me to wait a few more days to heal up, I would. After a couple of them looked and thumped and consulted, they decided I had one vein that would work. The tech hit the vein between two knuckles on my right hand on the first try and the tube filled quickly. (Happy dance!) Then it just … stopped. We still needed two more tubes.
At this point we’re committed because the order has been started in the computer, the labels have been printed and the first tube has been drawn. I won’t tell you how many times I got stuck trying for those last two tubes because it was WAY over how many times their lab policy says you can stick a patient. But I just wanted to get it done and not have to come back, so I told them to keep trying. Which they did. Time and time again. Finally, we found something that would work and they took only the bare minimum amount that they needed.
So, so far this week, I’ve been stuck 17 times. Sigh. #PinCushion indeed.
On a related subject, I don’t know why I have such problems with my MTX injection. I use a standard vial and syringe, but I have major issues getting the needle to go in. I’ve tried different gauge needles and everything I can think of. Today, in a discussion in a Facebook study group I’m in, someone mentioned that they use an autoinjector for their MTX injections and it works amazingly. Apparently you fill up your regular syringe, put the whole apparatus in the autoinjector and push the button. I’ve always preferred the autoinjectors for my biologics but I wasn’t aware that you could get them for use with regular syringes. Apparently a lot of people use them to give their pets injections. At any rate, I’ve ordered one. It should be here in time for my next MTX injection, so we’ll see. I’d be interested to know if anyone else has used these and what your experience has been.
So that’s my life at the moment. Colorful (at least black and blue) and full of holes. I hope you life is full of good things that make you smile. Thanks for checking in.
In the ninth of 10 things I’d like to go back and tell my newly diagnosed self, I talk about the unpredictability of RA and the frustrations that come with having to reschedule your life. Patience has not been one of my virtues, so having to deal with these issues has been one of the big lessons of having the disease.
Read the entire post here: https://rheumatoidarthritis.net/living/no-9-take-one-day-at-a-time/
When I get asked what positive things RA has brought to my life, I usually burst out laughing because the question is so absolutely ridiculous. Except for the fact that without RA, I never would have found the amazing community of people with RA. It has been my strength, my inspiration and my passion. I think this is critical to anyone with a chronic disease like RA.
Read the full article here: https://rheumatoidarthritis.net/living/no-8-find-community/
Sometimes it seems like RA can suck all the positive things out of your life, but it’s important that you enjoy your life as much as you can. In the seventh of 10 things I would like to tell my newly diagnosed self, I share some of this journey on rheumatoidarthritis.net here: https://rheumatoidarthritis.net/living/no-7-enjoy-your-life/comment-page-1/#comment-17987
So I had the second esophagus procedure this week, and that went pretty well. Hopefully that will solve the problem although there is a chance that I may need some additional testing, but not for a few weeks. Fingers crossed.
That’s the good news. The bad news is that the doctor discovered that what we thought was acid reflux is actually bile. So instead of taking one additional pill first thing in the morning, I have to take a huge tablet four times a day — 28 times a week. And I can’t take them with other pills or with food, so I’ve got this 4X a day thing that is completely offsync from anything else I do.
I counted the pills I take and it comes up to 30 pills per day which breaks into 20 prescription pills and 10 supplements. (Some of these are a single medication that I take multiple times per day.) That’s 210 pills per week or almost 11,000 pills every year. That’s not taking into account if I need Tylenol or other pain medication or Claritin for allergies, or anything else. In addition, I have a daily injection, a weekly injection, and an infusion every six weeks. Sheesh.
In other news, my knee has been bothering me since we came back from Havana. I wound up walking up (and down) three steep flights of stairs. Since that time, my knee has been getting more and more sensitive to pressure to the point that I actually nearly stopped walking. I was down to walking/limping the minimum 30 minutes a day then having to stop and rest/ice when I was done. Not a happy girl.
Last Friday I had an appointment with my orthopedic surgeon, since this is the replaced knee. Everything looked good on the Xrays. Where I indicated it was painful is on the bottom part of the knee where a tendon inserts into the knee joint and, assuming horses instead of zebras, my doctor did a steroid injection in my knee right there, just below the actual joint. Which is a good thing because you really can’t/shouldn’t inject into a replaced joint.
By the next day, Saturday, things had actually improved.
But then I did my personal impression of falling and not being able to get up. Directly on the knee.
We were at the movies and I had gone to the ladies room. On the way back I somehow tripped on the part of the floor that turns and starts to incline up into the theater, smacking my full (over)weight directly on the replaced knee joint. I couldn’t stand, I couldn’t breathe, it hurt so bad I couldn’t even cry. Of course it was a very loud movie and I didn’t think anyone could hear me, so I crawled/dragged myself along the floor until I got far enough into the movie theater that I got someone’s attention who went to find my husband and theater management.
Long story short, I found out that titanium is harder than flesh and bone (good thing). We went to the ER and, after Xrays and a couple of hours, they determined that the artificial joint was still firmly attached and none of the naturally occurring parts had been broken.
By the time we got home, I was able to put enough weight on it that I could get around with my walker and by the next morning I was walking without assistance, although with a limp. A week later it’s still very sore. I must say, however, that I don’t think I’ve ever had a more colorful bruise — even when I had the knee replaced originally. I was going to post a picture but it is still a bit too colorful for good taste. But it definitely has red, white, blue, green and purple hues.
The next couple of weeks are going to be busy with travel so I may be offline for a bit. In the meantime, I wish you the best health and happiness, and I thank you for checking in.
This is the sixth of ten things I’d like to go back and tell my newly diagnosed self about living with RA.
Being the micro-managing control freak that I am, asking for help is completely contrary to my nature. Having RA puts a whole new perspective on the situation. I share some of the things I’ve learned about asking for help (including how hard it sometimes is) in my recent article for RheumatoidArthritis.net here: https://rheumatoidarthritis.net/living/no-6-ask-for-help/