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Answers tagged biologic: Page 1 of 2
While biologics can be very effective at treating rheumatoid arthritis, they typically are not considered the first choice. In most cases, methotrexate remains the gold standard treatment. This is not just because it costs less, but in fact, when studied head to head, methotrexate works just as well as biologics do. When combined together, methotrexate and biologics are more effective. Overall, methotrexate is likely a safer option compared to biologics; and, well over 50% of individuals will go into remission on traditional DMARDs like methotrexate without needing biologic medications.
Kate from the United States asks: Is it normal to just try one biologic for inflammatory arthritis, or should more than one be tried until things feel better?
When it comes to inflammatory arthritis, like rheumatoid arthritis, psoriatic arthritis and others, the goal of treat is remission – no pain, no stiffness, no swelling, doing all the things in life that you want and prevent damage. We try to do this using DMARDs – both conventional ones like methotrexate or hydroxychloroquine, or any of our newer biologics. It is relatively common to try some of these in combination to get better effects. It is also common that we need to keep trying different DMARDs – including different biologics – in different combinations until we get it right and you feel better. While we typically only use one biologic at a time, trying more than biologic is very reasonable if the first one does not work. This of course assumes no other side effects or safety concerns because of other health problems one may have.
Yes, rituximab biosimilars are covered by the provincial drug plan in Alberta. In fact, all biologics listed on our website are covered by the provincial plan for inflammatory arthritis.
In most cases, we feel getting MMR on methotrexate is ok, even though it is an attenuated live vaccine. MMR should not be given to those on biologics however. For a full list of our vaccination recommendations, please visit our vaccine webpage!
Hayley from Calgary asks: I have recently gotten sick and need to know if I should continue my methotrexate injections or hold them while I am sick ?
As a general rule, it’s ok to continue traditional DMARDs (examples: methotrexate, plaquenil, sulfasalazine, leflunomide) when sick, particularly anything mild without a fever or needing antibiotics. For those on biologics, we generally recommend that they are held, particularly if you have a fever or require antibiotics, until you are feeling better. However, during the COVID19 pandemic, we are often a little more cautious and it would be reasonable to hold any DMARD – traditional or biologic – until you are feeling better. In most cases for methotrexate, this would mean missing one dose, which wouldn’t impact arthritis control for most individuals.
Please visit our COVID-19 vaccine information page, which we will keep updating as more information becomes available. At this time (January/2021), there is no information to suggest the currently available COVID-19 vaccines are unsafe for those with lupus or taking any medications for lupus. That applies to all rheumatic conditions, in fact. If you are still not sure after reading the available information, please contact your rheumatologist.
Jonathan from Calgary asks: Is there any specific advice recommended for rheumatology patients and COVID-19?
Please click here to our page on COVID-19. We will try to keep this information up to date, but the situation remains fluid.
Every province has slightly different rules for coverage of advanced therapies such as tofacinitib, and biologics. That said, in most situations, working with your current rheumatologist, or your new rheumatologist if you are planning a move to Alberta, a solution is found to ensure you can continue to receive the treatment that makes you well.
It is recommended that for biologic DMARDs, patients delay the medication during a severe illness, particularly if they have a fever, or require antibiotics.
Jackie from Albuquerque asks: I am worried I may have been exposed to HIV. I also have rheumatoid arthritis and am on a biologic. I have tested negative for HIV, but could my biologic be interfering with the results?
There are a number of different tests for HIV. Some could be impacted by a biologic in early infection, although data is not clear. To be sure, it is best to discuss this with your physician and rheumatologist. Conversely, it is important to be aware that being on a biologic can increase your risk of a more active HIV infection.