Question: TNF Blockers - When Should You Switch?
If an arthritis patient is on one of the TNF blocker drugs, when is it appropriate to switch to another? Is it possible for a patient to respond differently to another TNF blocker drug? Can a patient go back on one of the TNF blocker drugs after having stopped treatment?
We mostly hear about the TNF blockers, Enbrel (etanercept), Remicade (infliximab), Humira (adalimumab), Simponi (golimumab) and Cimzia (certolizumab pegol), but are some arthritis patients doing well with the biologic IL-1 antagonist Kineret (anakinra)?
Answer:
Starting TNF Blockers
At least 70 percent of patients with rheumatoid arthritis who start one of the TNF blocker drugs will get significant improvement in their condition. Even more patients will get benefit when methotrexate (Rheumatrex, Trexall) or another DMARD (disease-modifying anti-rheumatic drug) is combined with treatment.
- TNF Blockers - Test Your Knowledge
- Rheumatoid Arthritis - Test Your Knowledge
- Facts About DMARDs (disease-modifying anti-rheumatic drugs)
- Methotrexate for Rheumatoid Arthritis
Switching TNF Blockers - Now or Never?
If a patient does not respond to the initial TNF blocker after 3 months, switching to another will increase their chance of benefit. In fact, even if a patient has not responded to two of the TNF blocker drugs, another still may be useful.
- Enbrel, Remicade, and Humira - How Are They Similar and Different?
- Side Effects of Enbrel, Remicade, and Humira - Weighing the Risk Versus Benefit
- TNF Blockers and Skin Disease
- Why Is There an Increased Risk of Infection Which Occurs With the TNF Blockers?
Kineret (Anakinra)
Most rheumatologists have not used Kineret (anakinra) commonly to treat rheumatoid arthritis due to its decreased effectiveness and need to inject daily. However, Kineret has been very useful in those patients who have been diagnosed with a systemic form of juvenile arthritis called Still's disease.
- Juvenile Arthritis Screening Quiz
- Arthritis Is A Children's Disease Too
- Guide to Juvenile Rheumatoid Arthritis
If You Stopped a TNF Blocker
While patients who have stopped treatment with Enbrel and Humira can go back on the drug without concern, those who have been off Remicade for a prolonged period of time face the risk of infusion reactions which may be dangerous.
Answer provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association. Dr. Zashin is author of Arthritis Without Pain - The Miracle of Anti-TNF Blockers and co-author of Natural Arthritis Treatment.