Having gone through a slew of treatments options for rheumatoid arthritis in the past four years, it’s easy to begin to feel like a failure especially as I read about other fortunate RA sufferers who receive great benefit or even remission from first line medications like methotrexate and TNF blockers such as Enbrel and Humira. This feeling was exacerbated today when staying home because I felt too bad to go into work. In a period of no less than one hour, four commercials for Orencia and Humira came on the television (oh, as I was writing this sentence, a fifth commercial just came on!). These commercials show healthy, happy, and energetic looking people engaged in all types of activities that may be difficult for those with RA. Funny thing is, both of these medications failed to bring much impact let alone remission to me. I’m not alone as researchers discovered that 30% of patients on TNF blockers fail to reach even the minimal threshold for efficacy.[i] For some, including myself, there is some initial positive response but the impact diminishes over time. And for others, negative side effects or a reaction to the drug prevents them from taking it any longer.
After trying a boatload of RA treatments, I’m off to try a combination of RA medications that tend to be reserved for “failures” like me! My insurance approved Actemra in a fairly short time period – six days! I will have my first infusion tomorrow afternoon. According Genentech’s website,
“Actemra is the first humanized IL-6 receptor-inhibiting monoclonal antibody approved for the treatment of adult patients with moderately to severely active RA who have had an inadequate response to one or more disease-modifying antirheumatic drugs (DMARDs).”[ii]
And the American College of Rheumatology repeats this “failure” mantra…
“Tocilizumab has been approved by the Food and Drug Administration (FDA) for use in patients with rheumatoid arthritis who have active disease despite having been treated with one or more of five other biologic modifier drugs that block another cytokine, tumor necrosis factor (TNF), or who have been unable to tolerate such drugs.”[iii]
The good thing is that I should know fairly quickly if it is working since it is reported to start working within a few weeks.[iv]
The other medication that I started taking today is azathioprine (trade name Imuran). Once again, it appears that this drug, originally designed as an immunosuppressant for organ transplants, tends to be reserved for RA patients who do not respond or cannot take other more common DMARDS like methotrexate and leflunomide (Arava).[v]
Rheumatoid arthritis affects everyone differently as do the various treatments. This is evident in the many new medications being tested (see earlier post) and the recent approval of Xeljanz. I just have to keep reminding myself that I’m not a failure and that some combination of treatments will work! I’ll write a post about tomorrow’s Actemra infusion.
for most of my “career” with RA, I either did not respond or developed side effects that made the medication impossible for me.I strongly believe that there is a medication out there for you, but maybe it is currently in development. Hold on to the hope and keep rejecting this lunatic notion that people “fail” their meds. They don’t. The medications fail us, not the other way around
Keeping everything crossed for Actemra and you.
I really appreciate your “professional” perspective and encouraging words Lene.