Anti TNF and Biologics

dorcas

Morning helpline peeps

I wonder if you can explain the difference between Anti TNF s and Biologics?

I've been on Humira which is an Anti TNF but was given an alert card by ARC informing any health professionals who might need to treat me that I am a patient on biological therapy.

I'm about to start on Infliximab which I think is Anti TNF too.....

If they are different....can someone who has already been on the max of 3 Anti TNFs change to biologics?
this is my third Anti TNF hence the question!

It's a bit confusing, so it would be good to get some advice on it. thanks again. Irisx :roll:

helpline_team

Hello Iris,

Thank you for keeping us on our toes here, as we think easy questions are really boring!
It's a bit of a grey area. Anti-TNF drugs were originally known as biologic response modifiers, i.e. by blocking the creation of tumour necrosis factor they were modifying the body's biologic response.
They were three drugs with NICE approval in this category - etanercept (Enbrel), adalizumab (Humira) and infliximab (Remicade).
Then along came another drug called rituximab (mabthera) which had been originated as a lymphoma treatment which was found to produce excellent results in people with aggressive, uncontrolled RA. It's also a biologic but works differently to anti-tnf, targeting the body's b-cells. Rituximab is usually only offered to people who have failed on one or more anti-tnfs, so theoretically you could still be entitled to try it if infliximab doesn't work. But the grey area now becomes a cumulus nimbus because it hasn't had NICE/SMC approval in the treatment of psoriatic arthritis.
It gets worse. There's a new biologic, tocilizumab which has been approved in Scotland but not by NICE - we don't know yet if it can be used for PA and there's a new anti-tnf, certilizumab, which has just had NICE approval but not SMC as yet.
I hope you're paying attention - we shall be asking questions later.
I think I need to lie down now. Paul

dorcas

Oh MY God!!! run that past me again :shock: :!: I got lost at cumulus nimbus :!:
No wonder you need to lie down Paul after that lot !!!

You'll be glad to know I am paying attention but might have more questions of my own to ask of you later. ha ha!
All kidding aside, it was very informative...so thank you Paul...x

I am really fed up that other inflammatory arthers seem always to play second fiddle to RA when it comes to NICE and SMC approval of new drugs....why are the spondyloarthropathies given such a low priority?
are Arthritis Care campaigning about equal access to the anti tnfs and biologics for this group?

Tocilizumab hasn't been given SMC approval for PsA (I live in bonnie Scotland and asked my rheumy last week about it) My rheumy said he doesn't think it will be an effective treatment for PsA...something about it targettting b cells where the others target a cells? :!:

Certilizumab was mentioned by my rheumy as a better alternative but as you say it's not been SMC approved yet.

Heavens! you've given my brain cell (yes singular) a work out :!:

soooooo.....anti tnfs and biologics are the same only different??

at least I do feel as though there may be room to negotiate if my third Anti TNF doesn't work out . I'll just have to start working on Rituximab being made available for PsA!.

A BIG THANK YOU helpline peeps. :!: Irisxs

louiseb

Hi, wondered if anyone out there has been on adalimumab for any length of time and could share their experience please? I had my first jab today - I'm needle phobic and managed to do it myself, so was very chuffed! Having a very supportive nurse and hubby helped. It was very painful to do, so now have 13 days to psyche myself up for the next one...
What I'm wondering about is the side effects that we don't get informed about, such as certain foods / drinks disagreeing with you, weight gain / weight loss, insomnia or anything else that anyone may have experienced. Also, whether it has actually worked for you, as I've read that it only helps 50-60% of patients. I am thinking positive and hoping to be one of these people, as nothing has worked long-term in the 7 years I've had RA.
Thanks very much

dorcas

Hi Louise,
I've been on Adalimumab (Humira) for nearly five years for PsA and the only reason I'm coming off it is that my body has started to produce antibodies that have stopped it working for me.

In the five years I've not had any side effects from the Adalimumab..it's been the Mtx that I also inject that has always tended to cause problems (nausea, hair loss) but even that's well controlled by other meds.

I have put on weight ...but I think that's what goes in the mouth rather than the meds. :oops:

The Adalimumab in combo with Azathioprine and then Mtx worked really well for me for years..it's only been in the last year that arther has become so active again. My rheumy also thinks that stress has a major impact on flares and effectiveness and I can't argue that one!.

The jabs sting like a bee :shock: :!: so it's great you are managing the injects yourself...one wee tip from me...make sure there's no 'fluid' on the tip of the needle before you inject...that helps to reduce the stinging!

I assume you are going for regular blood tests etc to monitor it's effect?

Hope you get on well with Ada.....Iris x

ps. forgot to mention that like any of the antin tnfs, biologics or immuno-suppressants, if you do develop ANY unusual symptoms that suggest you might have an infection you should contact your rheumy department or GP to discuss if everything's OK.
Adalimumab can increase risk of infection and may mask signs and symptoms such as fever and pain so always get it checked out!
Iris x

louiseb

Hi

Well after my first jab I thought I was like one of my nurse's other patients, who felt better within hours. I woke up the next morning and the excrutiating wrist pain had almost vanished overnight. It was too much to be a coincidence. After about a week it came back, and I thought it was because my body was waiting for its next dose.

I did my second jab a fortnight later and am still in agony with the wrist. So although I think it initially gave me a boost, I now think it'll be one of these things that'll take up to 3 months, as I was told by my nurse.

As long as it works at all. I can't have Methotrexate or Leflunomide as they wipe out my WBCs too much. So it HAS to work!!!

Only side effects so far (apart from dying of pain when injecting - I'm needle-phobic!) are occasional nausea and a really bad tummy upset last week. Have noticed a slight weight gain. Is this coinciidental, does anyone know?

Kind regards

Louise

snowball

Hi Iris i have r/a and have had 2 anti tnf treatments but had a bad reactio to them so they put me on rituximab, i've been on it for nearly a year and we think it has stopped working. They are now talking about applying for funding for tocilizumab for me, wont know until i see my consultant (he's on holiday :roll: ) was told there are a couple of paitents on it already at my hospital.
Hope you are feeling better soon.
Julie

snowball

snowball wrote:

Hi Iris i have r/a and have had 2 anti tnf treatments but had a bad reactio to them so they put me on rituximab, i've been on it for nearly a year and we think it has stopped working. They are now talking about applying for funding for tocilizumab for me, wont know until i see my consultant (he's on holiday :roll: ) was told there are a couple of paitents on it already at my hospital.
Hope you are feeling better soon.
Julie

Anyone reading this who is about to start anti tnf don't worry about reactions i am allergic to most things anyway, my kids say i'm high maintinance lol Other people I know have been great with anti tnf and don't worry if it doesn't work straight away it can take up to 3 months.

Julie

dorcas

snowball wrote:

snowball wrote:

Hi Iris i have r/a and have had 2 anti tnf treatments but had a bad reactio to them so they put me on rituximab, i've been on it for nearly a year and we think it has stopped working. They are now talking about applying for funding for tocilizumab for me, wont know until i see my consultant (he's on holiday :roll: ) was told there are a couple of paitents on it already at my hospital.
Hope you are feeling better soon.
Julie

Anyone reading this who is about to start anti tnf don't worry about reactions i am allergic to most things anyway, my kids say i'm high maintinance lol Other people I know have been great with anti tnf and don't worry if it doesn't work straight away it can take up to 3 months.

Julie

Hi Julie,

Thanks for the info. Will keep my fingers crossed for you that you get started on the tocilizumab...it's licensed for RA but not PA (which is what I have ) I am hopeful that SMC will eventually approve it but the rheummy said he does not think it will be an effective treatment for PA so won't be considering that one for me!?...minefield isn't it?
I'm waiting to start on infliximab but it's been postponed now until after my wrist replacement op in June.....I've written to the ortho surgeon to see if he'll bring the surgery forward as I'm stuck now waiting and arther's playing merry hell with my joints!

I would ALWAYS encourage folks to try any of the anti tnfs or biologics if they get the chance....they can be so effective in slowing down the disease and are generally well tolerated......
and if for any reason you have to move on to a different one, so what?..it has to be worth it to keep arther at bay doesn't it?

keep well Julie! (((hugs)))

iris x

snowball

Thanks Iris hope you get your op sooner rather than later. I've beentaken off my leflunomide while my bp is high as you know, well its not helping my r/a and i've got this feeling they wont put me back on it.
You're right about more being done if you have r/a and i agree its not fair arthritis is bloody painful no matter which one you have. Good luck with your op and hope you get the treatment you need afterwards. Take care.
Julie xx