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Answers tagged biologics: Page 1 of 1
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David from Lethbridge asks:  I am being switched from leflunomide to a biologic.  Should there be a period of time that I stop the leflunomide prior to starting the new medication?

Whether or not medications can be taken at the same time, close in time, or need a brief break in time, depends on the medications being considered.  For leflunomide, it is common to use it at the same time as many biologics.  If it is being stopped, there is typically no reason to wait to start the biologic.  They should not interfere with each other.  For rheumatoid arthritis, it is, in fact, very common to use a number of the disease modifying medications (DMARDs) together, and often in combination with a biologic.  For instance, to be on methotrexate, hydroxychloroquine, and sulfasalazine at the same time is a common regimen known as triple therapy.  It is also common to be on a regular DMARD while on a biologic.  It is not considered safe to be on two biologics at the same time.

Q:

Tania from Edson asks: My family and I are planning our next big trip.  I know that the areas I can travel are limited because I take a biologic.  Can you recommend a good website or other resource for me to research this in more detail? My daughter hopes to visit all the continents!

For most rheumatology patients whose disease is under control, travel should not be a major issue.  Many patients are concerned because they may have medications that require syringes and needles, but your rheumatologist can provide you a travel letter which can be presented if requested by authorities.  For patients on intravenous medications, arrangements often can be made to ensure minimal interruption to your treatment.  The bottom line is to speak with your rheumatologist; if your disease is under good control, you should be able to lead a full and complete life.  If that includes travel, so be it!

Q:

Fanchi from Edmonton asks: I may have rheumatoid arthritis but have not been diagnosed yet.  What can I do, if my symptom continues, before I meet a rheumatologist?
If I have to use expensive biologic DMARD, is there any way to find some insurance plans that can cover most of the cost?

For patients with rheumatoid arthritis, the use of disease modifying medications is key to control symptoms AND more importantly, the underlying disease.  For a variety of reasons, it can take time for them to work, but there are other options to control symptoms, such as pain, while waiting.  While best to discuss with your own physician, anti-inflammatories (NSAIDs) are a good first choice for many patients, such as ibuprofen or naproxen.  Sometimes, cortisone injections into particularly painful joints, or even a short course of prednisone by mouth, could be used.  Physical therapy also has an important role to protect joints in this early phase of rheumatoid arthritis.

While expensive, rheumatologists in Alberta are usually able to work with patients to find a way to fund biologic medications.  It would be unusual to not provide needed treatment because of funding issues for most patients with rheumatic diseases in Alberta.

Q:

Audra from Edmonton asks: I am on methotrexate.  Is it safe to get the shingles vaccine?  What about pneumonia?

Vaccines, or immunizations, come in two broad forms.  Most are ok to receive when you have an underlying rheumatic disease and on treatment for it, including methotrexate or even biologics.   For that reason, rheumatologists generally encourage their patients to get the annual flu shot, and to receive the pneumonia vaccine as well.  However, for those vaccines that may have a live component to them, patients may need to be cautious depending on which medication they are on, as you may be at increased risk for developing the condition you are trying to protect yourself from.  While less concerning, these vaccines also may be less effective when on these medications.  If you are able to receive the vaccine before starting them, all the better.  It’s important to discuss the details of any live attenuated vaccine with your rheumatologist to ensure it’s right for you.

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Q:

Michelle from Sunny Island Beach asks: I have RA and Lupus and have been taking Methotrexate and Plaquenil in combination with rituximab. My insurance will no longer cover Rituxan but it will cover Humira or Enbrel. Is it possible to replace rituximab with a TNF blocker? My doctor told me I can’t “step down” from rituximab to another medication.

For rheumatoid arthritis, there is no clear evidence to suggest any biologic when used under optimal conditions is better than another. A patient would never be stepping down between different biologics, just switching. However, patients with lupus do need to be cautious with TNF blockers as they can exacerbate their disease. Rituximab is considered safer for lupus patients.



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