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Advice on first anti-TNF to try #282952 04/26/19 09:06 PM
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KatherineL16 Offline OP
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Hi all,

New to board. My name is Katherine and I live in Mexico City. I was diagnosed with AS after years of pain in mid 2018. HLAB27 positive. Great to meet you and looking forward to contributing.

I searched the forum for a thread on selecting a first anti-TNF to try, but didn’t find any recent threads (please correct me if wrong). I will be seeing my rheumy this week to select a first anti-TNF to try after a long run of anti inflammatories failed. I am guessing the options will include Humira, Enebrel, Cosentyx, and maybe others. Does anyone have good resources or personal knowledge about how to choose between the options? I know that the first few may fail, but am hoping to make the best attempt possible at lucking out the first time. I also know it will somewhat depend on what I can work out with insurance.

If it’s relevant, my main symptoms right now are tendon issues (chronic tendonitis in feet, groin, hip, hamstring, and shoulder), severe fatigue, brain fog, and intractable migraines.

Any advice, resources, or personal experiences are very welcome.


Diagnosed AS. HLAB27+. Naproxen, indomethacin, meloxicam, and ibuprofen failed. On Humira (first anti-TNF) since July 2019 with no result so far.
Re: Advice on first anti-TNF to try [Re: KatherineL16] #282953 04/26/19 09:44 PM
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Winston Online
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Since you aren't reporting any irritable bowel disease or uveitis, I recommend Enbrel as your first TNF. (If you had IBD or uveitis, I would've recommended Humira). I recommend Enbrel for four reasons: (1) you are less likely to develop antibodies to Enbrel than to one of the monoclonal antibody drugs, such as Humira (i.e., Enbrel is less likely to stop working for you); (2) according to my rheumatologist, people report fewer side effects with Enbrel than with some of the other TNF drugs; (3) it's one of the oldest TNF drugs, so doctors are very comfortable with it and there is some fairly long term data on its efficacy and safety profile; and (4) it's injectable at home, in contrast to a drug such as Remicade.

Re: Advice on first anti-TNF to try [Re: Winston] #282954 04/26/19 10:27 PM
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KatherineL16 Offline OP
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Thanks so much for the quick and very detailed reply, Winston. Great information to review with my rheumy.

Any other perspectives are welcome.


Diagnosed AS. HLAB27+. Naproxen, indomethacin, meloxicam, and ibuprofen failed. On Humira (first anti-TNF) since July 2019 with no result so far.
Re: Advice on first anti-TNF to try [Re: KatherineL16] #282957 04/27/19 10:57 AM
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Ken Delano Offline
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I echo Enbrel. I'm working on 15 years of using (-6 months when we tried Humira).


AS/PsA DX in 1988

Retired on disability
in 2005 at age 44
Re: Advice on first anti-TNF to try [Re: KatherineL16] #282958 04/27/19 12:54 PM
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WhiteCell Offline
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I found this interesting.

https://www.verywellhealth.com/comparing-enbrel-remicade-and-humira-drugs-189233

If you could describe your symptoms in greater detail it would be perhaps helpful. Age of onset morning stiffness and what medications you have tried which have not worked.

Bear in mind that one size fits all is not the norm as AS varies person to person. As Winston points out lack of involvement with gastrointestinal or eye issues would argue away from Remicade. The ability to self inject is a big plus in my mind. Efficacy varies so while statistics say the length of time until the anti TNF fails is a number of years, I've been receiving Remicade for nearly 20 years and it remains effective.

Finally, bear in mind that "biosimlar" medications are now on the market and are being encouraged by insurance companies to cut costs. While results of efficacy are good at this point, there have been scary contamination in production issues. These appear to have been resolved.

Take your time to make your decision and with your doctor plan your future with less pain...

La Vida!


Diagnosed AS 2001.
Started Remicade 2002 - 5mg/kg every 7 weeks.
Right Eye Trabeculectomy/lens replacement 2006.
Right eye DSEK Cornea Transplant 2009.
Right eye Ahmed Shunt 2016.
Right eye DSEK Cornea Transplant 2016.
Supra Ventricular Tachycardia. Radio Frequency Ablation 2008.
Cardiac Stent to RCA 9/2020

ICU RN - Seattle, WA
~Grasp The Challenge and Succeed~
Re: Advice on first anti-TNF to try [Re: Ken Delano] #282959 04/27/19 02:34 PM
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KatherineL16 Offline OP
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Thanks, Ken. I am so happy you found a medication that works for you
long term.


Diagnosed AS. HLAB27+. Naproxen, indomethacin, meloxicam, and ibuprofen failed. On Humira (first anti-TNF) since July 2019 with no result so far.
Re: Advice on first anti-TNF to try [Re: WhiteCell] #282960 04/27/19 02:41 PM
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KatherineL16 Offline OP
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That’s a very helpful article, thank you for sharing.

Happy to share more info. Onset at 26, and I am now almost 29. I do feel stiffer in morning or after sitting for long periods, but that is minimal compared with the chronic problems I have with my tendons that make it hard to exercise or even walk without pain. The fatigue is also a main symptom. Through now, I have tried just anti-inflammatories including naproxen, indomethicin, meloxicam, and ibuprofen, all of which failed.

As a note, as I work through the insurance process (which in my particular case will be at least 4 months but could be up to six), I will be on methotrexate to see if that works and I can avoid the biologic for now.


Diagnosed AS. HLAB27+. Naproxen, indomethacin, meloxicam, and ibuprofen failed. On Humira (first anti-TNF) since July 2019 with no result so far.
Re: Advice on first anti-TNF to try [Re: KatherineL16] #282962 04/28/19 03:30 PM
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WhiteCell Offline
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Four months seems like a very long time to see if it works. Anti TNF are becoming 1st choice for Rheums here in the US. The reasons for this can be picked out from this lengthy 2018 study below. You younger age argues strongly for TNF blocker therapy as long as you do not smoke cigarettes which studies show inhibits the patient response to the TNF medication. In addition TNF blocker therapy is more efficacious that Methotrexate alone by far.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5833172/


Diagnosed AS 2001.
Started Remicade 2002 - 5mg/kg every 7 weeks.
Right Eye Trabeculectomy/lens replacement 2006.
Right eye DSEK Cornea Transplant 2009.
Right eye Ahmed Shunt 2016.
Right eye DSEK Cornea Transplant 2016.
Supra Ventricular Tachycardia. Radio Frequency Ablation 2008.
Cardiac Stent to RCA 9/2020

ICU RN - Seattle, WA
~Grasp The Challenge and Succeed~
Re: Advice on first anti-TNF to try [Re: KatherineL16] #282963 04/28/19 06:45 PM
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drizzit Offline
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I choose SImponi and have been great for 8 years now. I travel a lot and the once a month dosing was perfect. Dragging enbrel around would have been difficult for me.

I also have iritis and Enbrel is not effective for eye issues. I also know SImponi has the lowest allergic reaction profile of all the TNF drugs and was designed to help reduce the antibody problem

Best of luck we all have different things we think aout when making this choice

Last edited by drizzit; 04/28/19 06:56 PM.
Re: Advice on first anti-TNF to try [Re: KatherineL16] #282964 04/28/19 09:56 PM
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KatherineL16 Offline OP
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Thanks for this article also, great info. Yes, ideally I could start biologics sooner, but unfortunately everything moves a little slower in Mexico, including getting specialized medications covered. The methotrexate is just to use in the meantime until I can work out a plan with the the manufacturers here.

I will discuss with my rheumatologist if I will combine the anti-TNF with a DMARD and/or anti inflammatory, but I’d also welcome your perspective.


Diagnosed AS. HLAB27+. Naproxen, indomethacin, meloxicam, and ibuprofen failed. On Humira (first anti-TNF) since July 2019 with no result so far.
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