Just when it seemed that Cimzia and I were going to have a long term, successful relationship, things have been thrown into doubt. Over the past couple of months, I noticed that the effects of Cimzia began to slowly taper and the days before the next injection that typically saw an increase in symptoms began to increase to weeks. I noticed that after I injected Cimzia late last month that relief did not come at all. My achilles tendons are very tender and the right one is so painful that I can hardly walk when I get up. My fingers are swollen, stiff, tender, and quite painful. Typing has gotten quite difficult the past few weeks. My right knee aches all day. And worst of all, the fatigue caused by RA is rearing its ugly head in ways I haven’t experienced in months. I even found myself refilling a prednisone steroid prescription the other day.
Cimzia is the second tumor necrosis factor (TNF) inhibitor that my doctor prescribed to treat rheumatoid arthritis. I started with Enbrel almost a year ago. The first few months brought great relief but then the effects began tapering. Unfortunately, after almost six months, the story is being repeated with Cimzia.
I’m beginning to wonder if TNF inhibitors aren’t going to work for me. I’m learning that this is not uncommon in the RA world. In a study by researchers in Australia, it was found that patients in clinical trials responded better to biological medications than patients in non-trial settings.[i] Selection bias in clinical trials may be implicated. One set of researchers from the Netherlands noted that 60-70% of people with rheumatoid arthritis fail to respond to tumor necrosis factor (TNF) inhibitors. [ii] Genetics, or “pharmacogenetics” as they call it, may play a role. People with certain forms of genes demonstrated a lack of response to TNF inhibitor drugs. They also noted that patients with high disease activity showed better response to the biological medications. The goal is to develop a method to predict the potential effect, or lack of effect, of TNF inhibitors in individuals. Such systems do not exist yet.
Whatever the cause, it’s back to the rheumatologist to figure out the next weapon from the arsenal that he’ll select. Unfortunately, this story is repeated for many RA sufferers.