Strength for today and bright hope for tomorrow

What exactly is a biologic medicine, and why are they so expensive? How do they differ from your NSAD's? And why do you need a hep and TB test? You better hope I haven't been coughing on you, or you might test positive for TB.

Jon, here's a copy/paste from spondylitis.org:

The Biologics: TNF Inhibitors

The Tumor-Necrosis-Factor alpha (TNF-a) blockers are biologic medications that have shown great promise in treating ankylosing spondylitis. Studies have shown that these drugs can potentially slow or even halt the progression of AS in some people. They have also been shown to be highly effective in treating not only the arthritis of the joints but the spinal arthritis associated with AS.

For a general overview of the TNF Blockers, you can click here to view the new insert discussing these medications that comes with our Straight Talk on Spondyllitis book. This book is internationally recognized as the most comprehensive resource available to help people understand and manage ankylosing spondylitis and related diseases. If you like what you read, you can click here to order Straight Talk on Spondylitis today.

In July of 2003, the first biologic medication was approved by the FDA for use in treating ankylosing spondylitis: Enbrel (etanercept). It is a self-injectable medication administered either once or twice a week.

The second medication in this class to be approved by the FDA for treating ankylosing spondylitis is named Remicade (infliximab). It was approved in December of 2004. Remicade is administered as an intravenous infusion in the doctor's office every six-to-eight weeks.

The other TNF-a blocker that has gained FDA approval for the treatment of AS, specifically, is Humira (adalimumab). It was approved in July of 2006. Humira is also an injectable medication, though only every other week, and normally self-injected.

The most serious known side effect of the TNF blockers is an increased frequency of infections, especially tuberculosis. Thus, a TB test is usually required before starting any of the TNF therapies. A very rare possible complication is increased frequency of cancer, especially of the blood (leukemia) or of the lymphatic system (lymphoma).

Thanks. Hope it works, and I hope you don't have to pay full price.

I wish you all the best. I didn't realize they were that expensive. My friend pays a copay of like $20 per injection. These kind of choices are always tough, hopefully the quality of life improvements will outweigh any side effects.

Jon - to add to the above, NSAIDs treat the symptom (inflammation), but biologics treat the thing that causes the inflammation (TNF). So it gets closer to the root of the disease, rather than acting as a band-aid, which is all an NSAID does. Biologics can actually induce a type of remission for some.

Yes, it was a tough decision, but one I became very comfortable with as I read more studies and statistics. If you only read the headlines, they are very scary drugs. But if you ignore the headlines and just read the statistics, they are quite well tolerated, and work as a miracle drug for many people. As in all things, media tends to blow things out of proportion.

Either way, it's a catch-22. The biologics can make A.S. go away, but work by suppressing my immune system. Obvious pitfalls there. But what are the other options? NSAIDs? NSAIDs kill more people per year than any other drug. I don't want to be bleeding internally 10 years from now, plus they do not slow the disease. DMARDs? They don't really work for A.S., plus are very hard on the liver. Nothing is truly safe, and doing nothing is the least safe of all. Having my spine fuse or going blind from iritis/uveitis do not sound like good options to me or my family, and the biologics can prevent that. NSAIDs and DMARDs cannot.

Yeah, they are enormously expensive, so I'll be one of the people acting as a drain on everyone's health care premiums. Until Obama fixes everything of course. ;-) But the drug companies actually help out a lot with aid. For instance, with a typical 80-20 insurance plan, Enbrel would be about $400/month AFTER insurance, but the drug manufacturer pays for most of the rest. 80% of Enbrel users end up paying $50/month or less. That's not a whole lot more than I'm already paying for meloxicam + omeprazole + sulfasalazine, which I won't' have to take anymore.

This is very interesting to me. My research is in arthritis. Now maybe I will start reading up on AS also.

James - is your research osteoarthritis or auto-immune arthritis? It's apples and oranges, as the former is purely mechanical and the latter is your immune system attacking your own body.

I just read this post, didnt see it before commenting on your other one.

I believe my sister took remicade but will check. it did wonders, without it she couldnt even move. psoriatic arthritis is autoimmune too, then hers just went away one day. a miracle.

Rooster - yeah, psoriatic arthritis is closely related to what I have. Same family of disease. I think it has the same gene type even. I'm crossing my fingers on the TB test, which will get read tomorrow. I went to Ecuador for a few weeks back in college, so hopefully I didn't come in contact with it. If I did, I'll have to do antibiotics for 9 months before I can start Remicade or Enbrel.

It's in autoimmune arthritis.

James - that's cool. There's a lot of research left to be done. I need you to find me a cure! Rheumatoid and A.S. are in different families, but A.S., reactive arthritis, undifferentiated spondylitis, psoriatic arthritis, Chron's, and ulcerative colitis are all in the same family of spondyloarthropathies. There's a lot there!

http://www.rheumatology.org/public/factsheets/diseases_and_conditions/spondyloarthritis.asp