Comparison of Biologics for Rheumatoid Arthritis (RA)
Which is best Biologic for Rheumatoid Arthritis?
Rheumatoid Arthritis patients often compare notes about which Biologic they recommend. Which Biologic works best for RA? Which Biologic has fewest side effects? Does anyone know?
Some new RA patients tell me that their doctors provide them with a list of Biologics and ask them to choose one on their own. Is there any way patients can find out which Biologic will work for them? Not yet, but they probably feel more comfortable gathering as much information as they can find before deciding.
Is there a comparison of Biologics for Rheumatoid Arthritis?
According to Wiley’s Cochrane Library, “there is a lack of head-to-head comparison studies.” However, in a report created by reviewing 31 studies in their database, Wiley provides indirect comparisons between abatacept (Orencia), adalimumab (Humira), anakinra (Kineret ), etanercept (Enbrel), infliximab (Remicade), and rituximab (Rituxan and MabThera ). Here is how they match up at attaining American College of Rheumatology’s ACR 50 which meant 50 percent improvement in the “number of tender or swollen joints and other doctor or patient assessed aspects of Rheumatoid Arthritis.”
- 44 out of 100 people who took abatacept improved compared to 21 out of 100 with placebo
- 49 out of 100 people who took adalimumab improved compared to 21 out of 100 with placebo
- 30 out of 100 people who took anakinra improved compared to 21 out of 100 with placebo
- 57 out of 100 people who took etanercept improved compared to 21 out of 100 with placebo
- 43 out of 100 people who took infliximab improved compared to 21 out of 100 with placebo
- 52 out of 100 people who took rituximab improved compared to 9 out of 100 with placebo
The authors noted that apparent differences in effectiveness may actually be due to differences in patient populations as much as differences in the Biologics. “Significant heterogeneity in characteristics of trial populations imply that these finding must be interpreted with caution.”
A recent comparison of 3 Biologics for Rheumatoid Arthritis
Adalimumab, etanercept, and infliximab were compared by Danish doctors who published a paper at the end of 2009. “Seventy percent improvement according to the American College of Rheumatology criteria (a ACR70 response) was achieved in 19% of patients after 6 months.”
Their findings: “Infliximab had the lowest rates of treatment response, disease remission, and drug adherence, adalimumab had the highest rates of treatment response and disease remission, and etanercept had the longest drug survival rates.”
Note: Remember, in this last study, treatment response was measured at ACR 70 which is stricter than ACR 50. Drug adherence and “drug survival rate” means that the patient did not quit the Biologic during the eight year period. Various studies have shown that patients who use Biologics with methotrexate show less RA damage than patients who do not. It is not known exactly why individual patients have better responses to a particular Biologic.
Edit: Thanks to Jakki for posting this link on Facebook right after this posted. New data on predictive biomarkers for RA treatment as I hinted at in the post. I mentioned that this study was underway, but how is this for timing? 😎 Haven’t reviewed this new info yet on the blog, but will soon. Kelly
Recommended reading:
- Comparing Risks and Benefits of Rheumatoid Arthritis Medicines
- How well do Biologic medications help Rheumatoid Arthritis?
- Methotrexate Side Effects
- Rheumatoid Arthritis Natural Treatment: The Beachcomber Article
This data tells me that using Biologics is a crap shoot, and response is probably dictated by your genetic makeup!
😎 Well, I’ve never played that game, but you might be right as far as choosing which one. On choosing whether to take one or not at all, odds are clearly better with them w/regard to damage. Looking at this does make it clear that they aren’t a panacea, doesn’t it?
This data is a bit underwhelming. Look at those rates of response. I’m on my fourth biologic now; having gone though Enbrel, Remicade, and Orencia I am now on Cimzia which appears to be kicking in quite well finally. However, thanks to this data, my next request, if Cimzia quits working, will be Humira. Amazing post Kelly, shouldn’t this be information that is readily available from a rheumatologist?
Anj, Thanks. You know – what always gets me is the ACR ratings. Sometimes I see ACR 20 used other times 50 or 70. There is a world of difference for a patient between 20 and 50 percent improvement… Plus, the improvement is from the patient’s baseline. If your baseline is “devastation and bedridden,” ACR 50 is much improved, but still disabled. It all depends. For those with milder RA, ACR 70 is practically “cured.”
I’m 6 months in to a psoriatic and/or rheumatoid arthritis diagnosis (docs are still figuring me out) and am not adequately controlled on metho alone. On Tuesday, the PA gave me brochures for Enbrel and Humira–our next step if an increase in the metho doesn’t work.
Crap shoot is exactly what I thought. And sounds like that’s pretty much what it is. THANKS for this timely post which tells me that me and my doc aren’t “missing something” that the rest of the world knows about. I can deal with uncertainty as long as I’m certain there is uncertainty 🙂
Funny. :chic:
Good luck, Kris.
Kelly-this all just points out to me that much work and study remains to be done….I think we should remain hopeful. It’s particularly interesting to me about the Danish study saying that Remicade was least effective. I was told by my infusion nurse that he sees about 75% of Remicade patients respond very favorably to it. Not that his opinion is on the level of a full blown scientific study but he does deal with quite a few patients. So we shouldn’t be discouraged. We, as a whole, should remain hopeful and keep getting the word out about RA and promote any efforts for more studies.
Yeah, that 40% mark seems to be the range for all of them, depending on the group of patients. I’m wondering about the IV nurse’s comments. 2 ideas: I’ll bet people feel obligated to say things like, “Yes, I feel better.” Also, I wonder whether the patients there are being treated by a good group of doctors who are being aggressive with combination treatment or any other variable that is giving them a better view of Remicade. Just questions.
The biggest surprise to me the steady 21% response with placebo. Like I always say, some patients get “better” anyway so it’ hard to know. And if 21 is half of 42, then what does that say about the 43/44% “success” at reaching ACR50? I’m not sure. Just thinking out loud, girlfriend.
I find those results really interesting based on my own experiences.
For me Enbrel worked to ACR 70 standards….for maybe 9 months. Then it randomly quit. My Doc indicated that I had probably built up immunity to it (even though on MTX) much faster than is “normal.”
So we tried Humira. That was horrible. It gave me terrible side effects and didn’t help me at all…so ACR (-10)?
Now I am trying Orenica. Since I am just starting I can’t give a fair verdict yet but I am hopeful. Bear in mind that MTX has been ever increasing through all this in an effort to keep me moving…
So I guess I feel that which drugs work must depend on genetics, your particular disease, or something other than just the drug itself…making it certainly feel like finding the right one is a crap shoot even though I’m sure when we get down to the science of it, if we had all the right information (isn’t that the kicker though) we could figure things out much more effectively….so…we arrive back at needing more research! 🙂
I was at an “information Session” last week, given by one of the drug company’s. They showed us a graphic that mapped out all of the know factors for inflammation in our joints and synovial fluid. (I’m not being precise here because I can’t find the handout)These included the “t” cells, “b” cells etc.. and the drugs that have been developed to fight each of these antagonists. I think that the speaker said that we have 19 biologic drugs being used now or in the pipeline to fight the various causes of RA. I asked if that meant that RA has many causes and she said that it did. I then asked if there are any kinds of tests available to know which kind we have and thus, which biologic would work for us. She said that right now we only have trial and error. But, there are several tests in the pipeline that will possibly be able to map our RA in order to more directly treat it.
Yes, that is exactly what I meant by “not yet.” Won’t that help some? I wonder what those tests would show for those who don’t respond to the meds? It’s very interesting to me. (Here’s an article posted on FB this a.m. relating to these new tests – click here.) Awesome to have such smart readers to talk w/. Kate, I’d love to know more about that session you attended if you want to email me sometime.
Wow – one of the most helpful posts for RA sufferers I’ve seen. I’ll bookmark this one.
– RA SB
BTW, it sounds as if Kate is describing the “Rise session,” which is sponsored by Rituxan. I went to one myself.
The way I tell people, 6 of the 8 curent biologics (its actually 9, but I never count Kineret b/c no one actually uses that one) are TNF inhibitors. One of those (Orencia) is actually a hybrid, part TNF inhibitor, part inhibitor of another T cell inhibitor. So if you fail 2 or more, it is likely that the rest will not work. My rheumy says she’s seen people fail like 4 of them and finally respond to one, but its VERY rare that happens. Then Rituxan is a B cell inhibitor, and then the new new one from Europe that is the IL-6 inhibitor. You would think after failing all of them, I would have tried one of the last two sooner, but my husband was scared of Rituxan, and my rheumy is scared of the IL-6. I finally said, “Enough. I’ve failed 5. I’m not even going to try Cimzia. Put me on Rituxan.”
If this one doesn’t work, its onto the IL6. I have this feeling deep in my bones that one of those WILL work. If not, I’m going back to Orencia, b/c I had at least a 40% reduction with that one…that was the best thus far.
-RA SB
So guess what I just found?
Well whaddaya know. Very interesting links, folks, especially that last one RA SB! Might lead to tailored drug protocol paths someday soon. 🙂
I guess I’m one of the lucky ones, both in my mildness and reaction to my biologic so far, three months in.
Thanks. 🙂
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Im presently getting Orencia Infusions. Im on my third treatment 2 weeks apart. My next Tx will be in a month and monthly after that. I have had very mild side effects, headache after Tx.and I take Tylenol and the headache is gone. I feel a little tired for a day. So far Im able to walk better and have less pain. I can do light housework now,but I have to rest after each chore. Considering that last year I was in a W/C and then a walker and unable to do anything, Im coming along well. I can walk without a walker or cane. My blood test were quite elevated and the swelling in my hands and knees were too. So my Rheumatoid Dr and I decided on the infusions. I understand that it takes a while until I get the full effect, but I’m optimistic.:o)
I am at a loss right now. I have been on Enrel for 5 years. I got sick with pneum. and bronchitis for 3 1/2 months (changed my general md after that) and then was sick with stomach mess from antiobiotics the idiot had been prescribing me. Needless to say I was back on Enbrel without metho. Then 4 wks ago went back on metho. Having a difficult time now. Dr. has said something about Orencia, but we have never tried Humira. Saw that some of you were having side effects with Humira. I have never had ANY side effects with Enbrel so I am terrified to change. Anyone got some input???? I am at a loss. (Also I would have to travel 120 miles back and forth to get IV’s., another downer)
Hi Teresa. I hope I didn’t confuse you – I didn’t have much side effects at all with Humira. I took a weekly dose for a couple of years and the only side effects were sore throats & also slow healing skin wounds which improved after folic acid was increased, so perhapst the methotrexate was to blame. I would not be afraid to use it at all – I just gave up because it did not stop the RA from progressing and my joints kept getting worse. Please don’t measure by my case – different Biologics work on different patients – Enbrel did not work either. Something to consider: the different ones work by a variety of mechanisms. Some block TNF, some B or T cells or IL-6… Talk with the doctor about when to consider switching mechanisms to increase your odds of finding a good match for you. I hope this helps some.
Do you need to switch because Enbrel does not work now after being off of it? Have you gotten back to your usual dose of mtx yet?
Yes, that helps a lot. I am on my usual dose of mtx, but have only had 3 doses. My new intern med dr along with rheumy said it could take up to 6 wks or longer for it to kick back in together. Also, I just came off antibiotic due to a sinus infection. It has been a crazy 8 months. Enbrel has been a lifesaver for me and I am praying that it really starts working again. As far as me being sick, I have never gotten as sick as I did. Unfortunately, I took a request for a dr. new in practice who didn’t have a clue and she really messed me up. Thank God I am with a great intern. med dr. now. I love your site. It has been such a great information tool and there are no groups in my area. I am 37 yrs old and have a 6 yr old so I really needed some support in my life.
Hi Kelly
First of all, thank you for all that you do. Your website and facebook page have been a godsend to me.
I have recently been placed on Simponi (golimumab). I posted in discussions for more info (non drug company)but no one I know seems to be on this drug. Can you find out more?
thanks
deb
Are you are looking for the success rate of Simponi? I haven’t taken Simponi, so I have no first hand info. We have had several readers mention using it. It’s just been lesser used because it is fairly new, but don’t they all look so similar on this chart? I’ll bet someone is working hard to make a Bioloigic that stands out above the others. As far as I know the side effects list looks about the same too. Wish I knew more, Deb.
Edit: by the way, Nancy on today’s post has just started Simponi too.
Thanks Kelly
I did message Nancy. I guess I was just looking for other’s experiences and info on side effects that didn’t come from the manufacturer. The cd and fancy booklet and the nurse that comes with this drug all sing it’s praises. Which is fine, but suspect. I was just looking for another reference I guess. I will keep searching and share what,if I find.
thanks for all you do. God bless you. You have been a lifeline for me.
This is an eye opener. Thanks for posting it. I will be armed for my appointment next week, when I will have failed two TNF blockers Enbrel and now Remicade. I don’t want to go on the same type of drug again. But I think he is proposing another one, I don’t know if its insurance or lack of choices.
Hi, has anyone had any experience with Actemra? It is a one hour IV Infusion done every four weeks at the hospital. My rheumatologist said this was a new drug to him and he doesnt know much about it, yet he put me on it because I was not responding to Enbrel or Humira. Any info would be greatly appreciated. Thanks, Trina
Trina, there are some articles here on Actemra if you click on the Tags List & then click on Actemra. Don’t forget the comments pages.
I took it last year & I know several patients who are taking it now. It works differently than the TNF inhibitors that you’ve had already so there is a chance it could work for you. Good luck.
WHAT ABOUT ACTEMRA? AFTER 13 YRS. OF ENBREL(RESULTS BECAME LESS ENCOURAGING). i’VE BEEN ON ACTEMRA WITH ENCOURAGING RESULTS. ANYONE ELSE TRYING THIS BIO?
I remember some 12 years ago being in a study at the NIH to determine the causes of RA and I recall the docs then telling me that an answer was just around the corner. Must be a long corner! (The study failed to reach a conclusion).
13 years after being diagnosed and on 22mg of metho per week – I thought was doing pretty well, till my shoulders started giving out on me. Now my rotator cuff tendons are 1/4 the size they should be and it hurt to use them. Looking back, I wish I had gone on the biologicals sooner, but my docs thought I was doing well enough without them and were a bit afraid of some of the potential side effects.
Mark
61 years old
Thank you Mark, for sharing your story. It’s important to show the variety of experiences so patients and doctors can learn from it.
After several treatments I was given methotrexate and enbral. It worked for 2 years and then failed. From there I went to Humira and Methotrexate. After 5 years it too has stopped working. I am now waiting to be treated with tocilizumab. I know very little about this drug and wondered if you can tell me if it is ok. Thankyou in advance.
What I’m mainly interested in here is that people commenting seem to have a choice in which biologic they use. Are biologics freely prescribed by doctors in the US? In Australia in order to qualify to try a biologic you have to firstly not respond to ‘first line treatments’ (largely MTX), as shown by inflammatory markers in the blood, before the government will consider giving you a prescription, then you have to keep getting blood tests and show an improvement otherwise they’ll cut you off. And because they take about a month to send the prescription there tends to be a lag time when you aren’t medicated (or you are on ineffective meds) while waiting for the prescription. This is so you can get the biologic at an affordable price. You can just opt to buy it outright without jumping through those hoops, but this costs over $1000 per month. So, I’m about 3 months into Enbrel treatment and while it worked unbelievably well for about 2 weeks, it then tapered off and now is almost not working at all. I have a prescription for another month or so, and then I don’t know what I’ll do, because my bloods are unlikely to show an improvement and then I’ll be cut off. Ideally I’d like to try Humira or one of the others but I can’t afford to spend $1000 a month on it. I know no one can really help with this dilemma, but I’m just interested to hear about how easy it is to get these meds elsewhere. Also, if anyone from Australia is on this blog and has any tips I’d appreciate it. Thanks!
Hello, I am curious if anyone has personal experience, family or friends on any form of “biologics” medical treatment? I had an appointment with my new Rheumatologist, who is awesome! It appears from my bloodwork that my Rheumatoid Arthritis is getting worse, despite the weekly methotrexate treatments. I will be returning to see him next Friday, to begin biologic treatments. He gave me brochures on 3 types; Remicade, Orencia, and Eumara(sp?). I was wondering if anyone has any experience or recommendations on which type to look into? I’m also curious about cost, per WebMD it looks as though they can cost anywhere between $1000 -$3000 a month. Any info would be greatly appreciated 🙂
I have been on Enbrel for 9 months and methotrexate for a year. Enbrel made a big difference for me. The manufacturers have programs available to significantly reduce the cost of these meds and your doctor should have info on those programs. I chose Enbrel because it would be easier for me to stay on a weekly schedule. Good luck!
While it may help by posting statistics on which medications have a higher effectiveness rate, it is more important to know that each biologic targets differently – i.e. B cells, TNF inhibitors, etc. As I understand, doctors cannot tell which may be the cause of a person’s RA so it is necessary to try several to find the right target. I don’t think it is right for a doctor to ask a patient to choose their medication, perhaps method, such as oral or injection, but the doctor should have better indication from symptoms and labs to know which would be best to start with. My doctor has taken me through a number of meds, some worked for a while, some did not work at all. But I trust her choice and try to learn as much about each prior to taking and then I can make my decision whether to move forward based on research.
There are different mechanisms which are targeted by the Biologic response inhibitors, but most of them (5 of 9) are TNF-alpha inhibitors.
The most important thing to know is that none of them work well in a majority of people with rheumatoid disease, so more research, and better treatments are needed.
Hate the very expensive copay of Humera. 3 times higher than pencil and the needle is not retractable after use..ugh. I can’t wait to change. Remodel has the most user friendly needle.
I’m a severe asthmatic with vocal chord dysfunction ( all my life ) then a couple years ago I was diagnosed with Lupus . Just now I’ve been diagnosed with RA too . Thinking of trying a biologic , but honestly reading all of these reviews has me very worried. I’m already on so many medications for these other problems and then reading the ” possible ” side effects of these new medications is just depressing . I’m in so much pain , mood problems all the time ( probably from long term steroid use ) , so much weight gain , constantly sick . Some days I can’t even get out of bed due to the pain and breathing problems. I Just want to have a better quality of life. I’m A 39 yr old single female trying to raise a 9 year old . My son is 20 . If I gave a full list of problems we’d be here all day . I’m getting so depressed by all of this. Can anyone tell me if it’s worth the risk of developing cancers , mental problems , MORE lung issues , ect . By trying these new biologics? Any hello is greatly appreciated .
Hi Sarah. I too was terrified of trying a biologic drug because of all the side effects. My doctor wanted me to try humira. I’ve had jra since I was 15. I finally decided to try it because nothing else was working, and I felt terrible. Surprisingly, I had a great response after the first injection. I’ve been on it for 14 years with no side effects at all. I know it’s easy to get scared by all the commercials listing all the possible side effects, but they are rare. It gave me a much better quality of life. I hope it does for you too. Don’t give up hope
Oh boy! My poor head cannot handle the thought that these might not work. It’s exhausting – one day at a time.