Trough test

By Porkypine

1 min read

I am on Humira and have been for about 6 months. At my last visit with my doctor, he asked how I was doing and I replied I felt the drug was working, but not for the full two weeks. He suggested a TROUGH TEST, which is a blood draw taken at the very end of the two-week period, which is designed to test how much of the drug is still in your system. Lo and behold, my measurement was way below the bottom threshold of normal. So my doctor increased me from one shot every two weeks to a once-a-week regimen. Amazingly, it worked and I feel so much better than I have for a long while.

If you are in a similar situation and feel like your drug is running out before the end of the two weeks, I suggest mentioning this to your doctor and asking about a trough test. (I am sure there is a complicated medical term for this but this is what my doctor called it.) Good luck!

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Jill.Brodie Community Admin
Hi <inline-mention username="Porkypine" user-id="6682406"/> thank you so much for sharing this with us. I am so glad you were able to get this test done and have been able to readjust your medication. It is so nice to hear how good you are feeling. We appreciate you being here! Jill, team member
Diane T Moderator & Contributor
Hello <inline-mention username="Porkypine" user-id="6682406"/> , This is a very interesting article. I never even thought of that at all. This is good to know. Glad you're doing so much better. Thanks for sharing. Diane (Team Member)
SareBear Member
I am so glad that your doctor was able to get your insurance company to cover this. Mine wouldn’t. My pain starts back up 2 days before my next shot and then my next shot takes 2 days to kick in, so I have 10 days of relief instead of 14. My doctor filled out all of the prior authorization and then appeal paperwork with the assistance of Humira’s manufacturer. It turns out that they have done studies on a weekly shot for PsA but never published it in a peer reviewed journal and never sought FDA approval for the weekly shot for PsA, but have for rheumatoid arthritis and other autoimmune diseases. So the manufacturer wasn’t able to share the data with me (FDA rules), but could with my doctor who used it for the appeal paperwork. As Humira is so expensive my insurance company used lack of FDA approval as an excuse for not paying for weekly shots. So I am now on a prednisone burst for those 4 days and when that wasn’t cutting it also got put on methotrexate. I was hoping to avoid generalized immune suppressants as I work teaching farmers indoors in NW MN all winter long and worry about catching EVERYTHING that might be circulating in the population, but in a for-profit health system…….
ClairG Moderator & Contributor
<inline-mention username="SareBear" user-id="5530395"/> - How have you been getting on with your treatment? Have you seen any relief from symptoms at all? -Clair <a href='https://psoriatic-arthritis.com' target='_blank'>Psoriatic-Arthritis.com</a> team member
SareBear Member
 <inline-mention username="ClairG" user-id="3280001"/> Yes, after I switched to Enbrel. However, it was my fourth weekly shot that sent up red flags. My leg swelled and got read and hot around the injection site, eventually leading to a bruise that I still have a month afterward. The following week was getting scary with the inflamed area actually spreading for 4 days and wrapping around my leg, eventually bruising. Thinking anaphylaxis may come with shot 6, I called my pharmacist. He urged me not to take the risk. So, while I have 3 perfectly good shots in my fridge, I am unwilling to risk my life for more relief. My doctor has prescribed rinvoq but I am getting jerked around her clinic’s prior authorization department and so i have been in a lot of pain. In the meantime, I am still on methotrexate and have begun taking prednisone again to knock back some inflammation, but that isn’t cutting it and seems to be out of my system by about 6 pm. I am traveling and speaking to farmers throughout MN for my job this time of year, and so this delay in treatment has been hard. 
1. Vickie Wilkerson Moderator & Contributor
 <inline-mention username="SareBear" user-id="5530395"/> have you tried contacting your doctor or even the nurse about the prior authorization department problem? Maybe they can do something about making the authorization go through faster. Just a suggestion. Vickie W., Team Member
2. SareBear Member
 Hi <inline-mention username="Vickie Wilkerson" user-id="3316344"/>- The problem was that the prior authorization department, that is in accessible by patients and seemingly resistant to admitting to and fixing mistakes, could not seem to understand what I was trying to convey in a game of telephone between them and me (with a patient liaison in between). It took me taking my phone into a public women’s room to talk to the liaison in between my presentations during a workshop I was teaching a half a dozen times last Friday to shake the PA loose. I finally received my medicine and after hosting a large bi state workshop in Fargo this week, I need it to be instaneously relieving….. no inflated expectations or anything….
Mary Lynn Member
 <inline-mention username="Porkypine" user-id="6682406"/> , this is helpful information. My Simponi Aria infusions are every 8 weeks. I fall into a "crap gap" about 2 weeks before my infusion is due. Christmas found me in a giant flare, 10 days away from an infusion. I would rather not feel that yucky at the tail end of every infusion so I will mention this test to my rheumatologist. Thanks!