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Switching back to previously used biologics?
#275326 07/14/16 12:02 AM
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So I have been taking Humira for about 4 months. I've received some benefit, but not as much as desired. So I'm going to try Embrel. What if I wanted to return to Humira some day? I've heard that some people have difficulties returning because the body more or less becomes resistant. How common is this? And if anyone knows, what is the biological process that results in resistance to the drug after one stops using it?


Early 30's male, HLA Negative, AS diagnosed Feb. 2016, Humira.
Re: Switching back to previously used biologics?
obrienk84 #275327 07/14/16 12:19 AM
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One more question--I've heard there are ways to decrease the probability that you will fail a biologic, for example, by taking SSZ or another DMARD during the transition. Is this true? I'm on SSZ.

Last edited by obrienk84; 07/14/16 12:19 AM.

Early 30's male, HLA Negative, AS diagnosed Feb. 2016, Humira.
Re: Switching back to previously used biologics?
obrienk84 #275332 07/14/16 01:51 PM
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Are you sure you don't want to give the Humira a couple more months? My rheumy recently told me that it is now advised to stay on a biologic for at least 6 months before stopping because it takes that long to determine if it's going to work.

Re: Switching back to previously used biologics?
obrienk84 #275333 07/14/16 02:38 PM
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I have been on and off enbrel for about 12 years. Never had a problem going back.

Re: Switching back to previously used biologics?
obrienk84 #275334 07/14/16 04:00 PM
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Some people develop antibodies to a biologic, which causes it to be less effective. (The antibodies are specific to the biologic being taken.) I don't know the statistics as to how common it is. Adding a DMARD can help reduce the effect of the anti-drug antibodies. I think I've read that MTX works better than SSZ for this purpose, but don't quote me on that.


Ginny - 58 year old female
Dx with USpA in March 2013; changed to AS in July 2015
Iritis and Scleritis, both currently in remission
unicompartmental knee replacements: right-June 2014, left-Aug 2018
MTX, Humira, Cyclobenzaprine, plus Celebrex as needed
Supplements: Folic Acid, Vitamin A, Vitamin D, Calcium, Fish Oil, Culturelle probiotic, Melatonin (as needed)
Re: Switching back to previously used biologics?
obrienk84 #275335 07/14/16 04:43 PM
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In the case of Humira, there is a blood test to check for antibodies (which are rare.) and blood levels of the med. If on the fence at this point, it may be worth having done. In any even 4 months is not an adequate trial for any biologic especially if you are experiencing any relief which typically doesn't start until month three anyway. Of course some folks get relief quickly, but by the same token others (in similar numbers take longer.) I have not heard of SSZ reducing the effect of the anti-drug antibodies but yes MTXis frequently used for that purpose and has been included in most trials

Re: Switching back to previously used biologics?
obrienk84 #275336 07/14/16 05:47 PM
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I have taken Humira three different times, each time it worked but only for a couple months...when it failed again.

MTX is the med recommended (and which I took) to prevent you from failing it and also boosts it strength. Arava is also used but not given to women of childbearing age. SSZ not so much.

I failed many of the biologicals. They all worked well, a miracle but then after 3/6 months turned to water over night. Terrible to wake up just like before. MTX really helped for years starve that off, until MTX stopped working.

Dr told me living with the disease, untreated for many years is the reason my body adapts to the drugs. Luckily they kept inventing more. smile


Actema IV once a month (with pre loading for allergic reaction), Cymbalta x1 daily, Arava 20mg daily. Diagnosed with AS in 2004, suffered undiagnosed since 1982.
Re: Switching back to previously used biologics?
Winston #275338 07/14/16 06:39 PM
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Originally Posted By: Winston
Are you sure you don't want to give the Humira a couple more months? My rheumy recently told me that it is now advised to stay on a biologic for at least 6 months before stopping because it takes that long to determine if it's going to work.


Not sure of much to be fair. Humira sometimes feels like it is working well, and other times I feel pretty bad. But I've already gone on double Humira dosage. And one of my doctors is concerned that this is a lot of Humira. The other suggested I switch 6 weeks ago, because there are so many options. And now I already have new doses of Embrel, so I'm afraid it is too late to switch back to Humira, unless I don't take them, or take the Embrel for a couple weeks and then switch back.


Early 30's male, HLA Negative, AS diagnosed Feb. 2016, Humira.
Re: Switching back to previously used biologics?
tntlamb #275339 07/14/16 06:50 PM
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Originally Posted By: tntlamb
In the case of Humira, there is a blood test to check for antibodies (which are rare.) and blood levels of the med. If on the fence at this point, it may be worth having done. In any even 4 months is not an adequate trial for any biologic especially if you are experiencing any relief which typically doesn't start until month three anyway. Of course some folks get relief quickly, but by the same token others (in similar numbers take longer.) I have not heard of SSZ reducing the effect of the anti-drug antibodies but yes MTXis frequently used for that purpose and has been included in most trials


I actually experienced immediate relief on Humira, but it was never perfect, and my rheumies both seemed very willing to switch me within 3-4 months. And one is at Stanford, so I figure they know their stuff. Their POV is that there are so many options now, why stay on one for a super long time.


Early 30's male, HLA Negative, AS diagnosed Feb. 2016, Humira.
Re: Switching back to previously used biologics?
obrienk84 #275348 07/14/16 10:14 PM
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Its important to have confidence in your team. But it is also important for your team to have confidence in the research already done. There are NOT a lot of options for biologics effective for AS, despite the fact there are consistently more biologics becoming available. In fact the move in biologics for AS is towards something entirely different than TNF inhibitors. (interleukins) There are still only 3 anti-tnfs approved. Others may work though.

There is significant research about time of response especially with AS. We don't have a simple "arthritis" that most rheumies are most familiar ad experienced with. (nothing simple about arthritis BTW)

I can't disagree with the concept of lets try to find something effective as quickly as possible and I wish you luck with Enbrel. I still think its the best. I wish that the subsequent meds I have used since Enbrel (after six years)being forced to another med because of uveitis were as good for my axial pain. The good news is what appeared to be inevitable fusion stopped dead in its tracks when started the bios. I can deal with pain in other ways.

I would suggest however you don't give Humira a failing grade. You may well want to return to it someday. Whether it is eye issues or disease progression.

Last edited by tntlamb; 07/14/16 10:24 PM.
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