Humira not working. What next?
I was diagnosed with PsA last summer and started on Humira in August. I found some minor improvement but not great (went from 9 down to 6 inflamed joints and from 3 toes with dactylitis to one toe). The tendonitis, bursitis and enthesitis in my foot improved but didn't fully resolve. In November, I went from forthnightly to weekly doses. The only improvement I noticed from that was a quite sudden increase in flexibility in one finger.
At the moment, I have a fair bit of pain in my SI area, stiff and sore neck, one hammer toe, sore thumb and one finger I can't straighten. A couple of other fingers are sore too and my ankle can be iffy too. The symptoms ease a bit for few days after the injection.
So I'm assuming the Humira isn't working. I'm also assuming it's not due to me making antibodies against it as it never really worked so adding methotrexate to the regime probably won't help. Plus I'm keen to avoid this as I understand the side effects aren't great.
What has worked for others if Humira hasn't? I don't have the restrictions on drugs that many of you in the USA seem to have due to insurance or in the UK due to NHS cost guidance. I'm in Ireland and the rheumatologist will prescribe whatever she feels is best and, provided it is covered under the drugs payment scheme, I'm covered except for the family maximum payment of €80 pm.
Hi
, thanks for reaching out here. I'm sorry to hear that your current regimen of Humira doesn't seem to be bringing you relief. Treatment certainly is a lot of trial and error to find the best fit, not only which gives the best relief but also with fewest side effects. It sounds like you're still having a lot of symptoms that are not feeling well-managed, so it makes sense that you're ready to see what else is available to try.
I hope some of our community members who tried other medications after Humira, especially if they're also in Ireland, can chime in and share with you. Unfortunately, my best advice would be to reach out to your doctor and they might have a certain medication they typically suggest after Humira. I will also share some information with you about treatments, https://psoriatic-arthritis.com/treatment. As well as this one about medications, https://psoriatic-arthritis.com/medications. The good news is, there are a lot of different treatments available for PsA treatment, so just because the Humira doesn't seem to be doing the trick for you there are many others available for you try to get you the best relief possible.
Please, if you're comfortable, keep us updated, and hopefully you can get some helpful feedback here as well. Wishing you a gentle day. -- Warmly, Christine (Team Member)Thank you. I'll have a look at those.
Generally, most rheumatologists will transition a patient to a different drug in the same class before changing to a different class of medications. Humira being a TNF blocker, that means you will probably be put on Enbrel next. But, you can always request a different biologic altogether, something like Cosentyx or Skyrizi. Or you can try a JAK inhibitor like Xeljanz or Rinvoq, or a PDE4 inhibitor like Apremelast. It's ultimately up to you. Your rheumatologist should be able to give you proper guidance on this issue.
Thank you. I'm just wondering what is the logic behind going to another drug in the same class? I would have thought if a TNF inhibitor wasn't working, that would suggest TNF is not the problem and you need to inhibit something else?
I know everyone is different but is there any research that anyone knows of that suggests the best way to progress in terms of drug progression?Hi
, what a great question! Eric shared an article (below) that has some information on the studies done on this. Ultimately, though, it's up to you and your doctor to decide what you're comfortable with trying next. -- Warmly, Christine (Team Member)
Studies have been mixed on this. https://www.rheumatologyadvisor.com/features/switch-or-swap-strategies-for-anti-tnf-failure-in-rheumatoid-arthritis/
thanks for sharing this article! This is very interesting (and helpful information). -- Warmly, Christine (Team Member)
