Medication Updates

Y’know back in the day … the most intense medication I had in my cabinet was OTC NSAIDs or some cold medicine. There were a lot of vitamins and minerals around the house … and I took them regularly. These days … it’s a whole different story!

One Rx NSAID and two DMARDs later (and Rx vitamin too) I have one more decision to make. My rheumatologist believes in treating this (luscious) RA aggressively and I agree with him. So we are going to add a biologic on top of everything else. But which biologic is now the big question?

I have to consider my health insurance company’s tiered formulary, because a biologic moves out of the Tier 1 drugs I now take. The rheumy suggested one drug that’s in Tier 2 and another that’s in Tier 3. And two more that aren’t in the formulary at all. Picking my battles, I feel like I should start with the Tier 2 drug … considering it’s more likely to be approved.

Tier 2 drug: Humira
Tier 3 drug: Enbrel
Non-formulary: Orencia or Remicade

I’m also looking at some of the practicalities of my life. I’m not needle-phobic although I’ve never had to inject anyone else much less myself. So maybe an injectable would be okay. If I can’t do the injections, then my husband will be another option. Although he swears he could never do it … and I tend to believe him! I also like that Humira is bi-weekly or weekly.

At 45 I still have good veins in hands/arms. So it wouldn’t be hard to do infusions, but why start there yet? I also know that I don’t sit still very well unless I’m completely exhausted. So the idea of sitting for an infusion doesn’t seem like a lot of fun. I’m also a small-business owner and making money depends on my presence. So that’s another nail in the infusion coffin.

I’m really leaning towards Humira, despite all the dire warnings and possibilities of major side effects. There isn’t a single biologic that doesn’t have similar warnings. Additionally, I have read some very positive reviews of how much it has helped RA patients. And the alternative of joint damage just isn’t an option I’m willing to take lightly.

If you were in my shoes (what you know of them), what would you do? Thanks!

6 Comments

  1. erica
    Feb 24, 2010

    I do both, I have a drug that is an injectable and another that is an infusion, check your policy for what is called “Step therapy” they may make you try the teir 2, before anything else, hence the stepping up

  2. Kami
    Feb 24, 2010

    I had great success with Humira. I chose to go on Humira after my doctor telling me that their office is part of the longest running clinical research trial (which is still ongoing) of Humira. He has personally followed many of these patients. I found it very easy to inject via the self-inject pen. Initially, while my body got used to the medication, I had a good bit of sinus issues. Not infections but inflammation. These were resolved by taking an Advil Cold and Sinus (pseudoephedrine-the stuff they will card you for!) an hour before my injection and one 6 hours later. Humira stopped working for me in October and I feel that it is directly related to the fact that I cannot take MTX. I am a firm believer that you need to take MTX with most of these meds to make them last longer! (Just an opinion… not a fact!) I felt GREAT on MTX and Humira but the side effects from MTX were too much for me to handle.

    Humira is manufactured from human based antibodies. Enbrel is not. I do not know where the ones from Enbrel come from but I was told by someone it was mice. I find that hard to believe but who truly knows, right?

    Best of luck with your decision. I am 40 and have been battling this for 2 years. I am REALLY looking forward to starting Remicade on Monday. I will be sure to keep you updated!

    Kami

  3. Andrea
    Feb 27, 2010

    I would probably do the same thing as you are learning towards. Health insurance sometimes dictates what medication you use, but if another medication will actually improve your RA symptoms I would consider it.

  4. thislusciousra
    Feb 28, 2010

    Thanks everyone for the comments and support! So here’s the update: we didn’t start any biologics this time. I have to do the Hep and PPD testing first, and then we’ll decide what to do in six weeks. So … as it often happens … all that worrying for nothing. But either way, my decision is mostly made.

  5. amandajohn
    Mar 9, 2010

    Hey,

    I’m on Humira and highly recommend it. I do the pen injections which are foolproof (so far). As far as cost and insurance, ugh. My policy does that lovely Tier 4 pricing where I have to pay a percentage of the cost ( I think it’s 20%) rather than a copay. You definitely want to check on that but it sounds like you already have. Another good thing about Humira (which is how I afford it) is that they have a patient assistance program. There are links on their website to it- I literally found it by accident. Right now, because of the pap, my copay is $5 a month. Good luck in making your decision!!!

  6. Michelle
    Mar 25, 2010

    Hi! Nine years ago I was diagnosed with RA. Recently I was sent to the Cleveland Clinic and told I have Mixed Connective Tissue Disease (MCTD), basically it means I have symptoms and test positive for various Connective tissue diseases, for me its RA and Lupus. I took Enbrel for about 3 years. It worked AMAZING, I loved it, and eventually stopped taking it, not because it had stopped working, but because I was doing so much better I had been gradually stepping down the amount I was taking and was able to stop and not relapse. Its been over a year since I’ve stopped taking it and didnt have problems again until recently. Because most of my current symptoms are Lupus related, my dr’s not putting me back on it. I would totally recommend going for the Enbrel–and I’m so happy one of my college professors had recommended it to me. It took a prerequisit letter from my dr, but as I’d been on almost every NSAID drug available, my request was granted. Good luck with your insurance company! I know it can get frustrating. I hope whatever you end up taking works out well for you!

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