Question
I am sero negative RA (Still’s Disease). Because of initially diverse symptoms,diagnosis took a long time. When referred to a rheumatologist, she worked it up pretty quickly. Anyway, have been on methotrexate for several months and symptoms are actually worse. Prednisone taper worked for short time, but symptoms come back. Now on 7.5mg prednisone every AM in addition to the methotrexate. She would like to start me on the biologics and has given me information on the 3. In her experience, she has seen quicker response with Remicade (IV) than the injectables (Embrel and Humira). Possibly “related to the individual differences in tissue absorbtion of the injectables”. Other than that the way the 3 drugs work is pretty much the same and they have the same side effects. In addition to the usual questions that relate to insurance coverage, I am interested to know how your patients consider the convenience factors. That is, IV, 2 hours in the office every 4-8 weeks vs, weekly or bi-weekly injections. Also, have you seen much difference in the 3 drugs and from a cost basis, how does 6 doses of Remicade go up against 26-52 of the injectables.
Answer
I do not think the convenience factor is a big issue. Most patients receive Remicade very 2 months and thus the 2 hour infusion is not much of a big deal. Most use the time to nap or catch up on reading. However in the workalcoholic world, many of the younger working patients prefer the self injectionables. The cost of the agents is relatively similar, but Remicade is more expensive if the dose is increased. Humira can also be more expensive if increased to weekly dosing, but most patients are on every other week dosing.
