RA|QA Rheumatoid Arthritis Questions & Answers

QuestionAshley asks:

I’m finding that there is very little information available about a combination of drugs I will be starting soon. I posted an entry on my blog about it but I’m having little to no luck. The combination I’m mostly concerned about is Rituxan and Humira. Supposedly its still a somewhat rare combo. Not to mention the methotrexate and Prednisone. I was hoping there was someone else who is on these that could give me some insight.

10 Comments
10 comments
  1. Cammie says:

    Wish I could help you. I am doing Enbrel, plaquinil and methotrexate myself. However just yesterday they took me of the the Methotrexate for awhile as it is starting pile up in my liver. So I’ll be off of the methotrexate back on the prednisone for a while.
    Good luck finiding info on this combo.
    Blessings,
    Cammie

  2. Elaine C says:

    I reside in the UK. I hope we can help each other. I am on combination therapy. Initially started with Methotrexate. Due to the former not having an effect. 10 months later prescribed with Hydroxichloroquine (Plaquenil:Anti-malaria & Anti-Inflammatory) & Sulfasalazine (Anti-inflammatory) in conjunction with Methotrexate. Although with this combination I improved though not significantly. I was offered for consideration Humira which I have been injecting since last September. Some joints inflammation as been reduced.
    I have not heard of Rituxan hopefully on my next consultant visit my Rheumatologist can enlighten me.

  3. Kevin says:

    I received a Rituxan infusion in early September 2009 and then started Humira in mid November. As you probably know, that’s considered a combination because of the long-lasting effect of Rituxan. I’m also taking Prednisone, Naproxen, and Arava.

    It was a battle with my rheumatologist to allow me to do this. He was concerned about the risk of infections, even after I showed him several (admittedly small) studies that demonstrated that the combination is not significantly more risky than either drug alone. His other concern was that my insurance company would not be willing to pay for both drugs.

    Previously (December 2008) I had tried Humira alone and while it helped me significantly I still had a lot of inflammation and pain. The same was true with Enbrel.

    All told, I was taking Humira once a week for about 6 weeks after my Rituxan infusion, and my improvement was immediate (within a couple of days) and dramatic. I have not had any side effects. I wouldn’t call it remission, but in less than six weeks I went from being unable to climb stairs to being able to do one of my favorite hobbies again: rock climbing. That’s a pretty big improvement.

    However, my rheumatologist has now convinced me to try Orencia, so I’ve stopped taking Humira. It’s too early to tell how that is going…

    I hope this helps, and good luck!

  4. raandme says:

    Hi guys,
    This is Ashley. Thanks for the replies :)
    Our stories are pretty similar Elaine. I’ve been on a combination of just about every drug available, including the ones you listed.

    My first TNF inhibitor was Enbrel and it was the first drug that had any affect. The first drug since I was diagnosed that showed any change with my inflammation markers in my blood test. Unfortunately within a few months it stopped working so well. I’ve found that Humira followed the same pattern.

    So my Rheumatologist ordered Rituxan. It is an I.V. infustion. Its chemotherapt. The same chemo they use on cancer patients but in a much smaller dose. I didnt have any side effects or anything. But the concept is that is wipes out your immune system which should kill off the white blood cells that attack the joints.

    I guess mine are extra resilient because the two rounds of rituxan had no effects on my inflammation markers.

    So… blah blah blah. Long story short. My doctor wants me to go make on Humira as well. Im already on methotrexate and have been on Prednisone for two and a half years. Which no one here needs to be told, totally sucks. :)

  5. Sister FlareUp says:

    Sounds like too much to me but I am not a Rheumatologist. I would advocate for myself and get someone else on board, a Pharmacist might evaluate and qualify the use of this combination. I am grateful everyone of these drugs are available and for the services of my MDs but would like to be advised when treatment becomes experiment. How about you?

  6. raandme says:

    Kevin,
    Thats amazing! Especially the fact that you felt an improvement in days. That gives me some hope!!!
    Im also glad to hear about the studies you found about the combination not being that much more risky. I havent found anything like that, so that is also a load off my mind. Ive never had any negative side effects with my meds, but Im getting to the point where Im on so many that it’s beginning to make me nervous.
    Thanks again!

  7. Melissa says:

    I know we’ve talked about this before Ashley, but it is pretty interesting to see of more and more RD’s prescribing 2 and 3 DMARD’s. I remember when just Enbrel and mtx alone was sure to suppress more than enough. Now it seems like tougher cases are adding double doses or a 3rd DMARD.

    I hope you find some answers soon. When I started to take a 2nd dose every week of Enbrel I have to admit, I was a little freaked but the change was immediate.

    I hope the same for you. Keep us up to date.

  8. Kevin says:

    Ashley,
    When I first tried Humira back in December 2008, I had a significant response within 2 days then as well. I was very surprised at the time because I was under the impression it was supposed to take at least a couple of weeks. Later when I tried Enbrel (because my response to Humira was immediate but insufficient) it took much longer for that to have an effect – several weeks at least.

    Here are some of the published articles I’ve found on the combination of Rituxan and a TNF agent. The last is the largest study and the most recent:

    http://www.jrheum.org/content/36/9/2125.2.long
    http://rheumatology.oxfordjournals.org/cgi/content/full/48/4/440?ijkey=e631c0701242aae50f4a2158f4838a28519efeb5&keytype2=tf_ipsecsha
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684711/?tool=pubmed
    http://acr.confex.com/acr/2009/webprogram/Paper14931.html

  9. Kevin says:

    You probably know this already, but when reading the papers I linked, rituximab = Rituxan, etanercept = Enbrel, and adalimumab = Humira.

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