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If Your Biologic for RA Fails: What Next?

New biologic drugs that target the underlying cause of rheumatoid arthritis symptoms have helped many people with RA. But what happens if you try a biologic and it doesn’t work?

It's not uncommon to try more than one biologic before finding one that helps your RA significantly. Fortunately, there are several biologic drugs to choose from. If one doesn’t work, chances are good another will. According to the Arthritis Foundation, most people eventually find a biologic that helps them, although the degree of relief varies. Some people feel partial relief, while others go into remission and are symptom-free.

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What to Expect From a Biologic for RA

There are several types of biologic drugs for RA, and each targets a different part of the inflammation process.

In most cases, you should notice some relief of symptoms within four to six weeks of starting a biologic to treat rheumatoid arthritis. During this time, your doctor will probably prescribe faster-acting medications to help ease symptoms.

If your symptoms don’t improve significantly after a few months, your doctor will probably prescribe another type of biologic drug. Timely treatment is important to slow or stop the progression of RA, so doctors don't want you to spend too much time on a drug that isn't working well for you.

Although biologics are effective for many people with RA, these drugs don’t work the same for everyone. Some people get total relief from RA symptoms, while others only get partial relief. 

Experts don’t know why some people benefit more than others. But they do know this: People who are treated in the earlier stages of RA tend to get more relief than those who have had RA for many years. Biologics are also most effective if you take them on a regular schedule. If side effects prevent you from taking your biologics regularly, talk with your doctor about your options. If finances are a concern, your doctor may be able to point you towards a program aimed at helping people with RA pay for their medications.

What If Your Biologic Drug Stops Working?

In some cases, biologic drugs will work for a while and then become less effective. It’s not clear why this occurs. And there is no way to predict if this will happen to you. But if it does, don’t panic. Talk to your doctor. Your doctor will probably prescribe a different type of biologic, or a combination of a biologic and other drugs. Taking a biologic with a traditional DMARD such as methotrexate or sulfasalazine can often make your treatment more effective.

Your Choices in Biologics

Anti-tumor necrosis factor (TNF) drugs were the first biologics developed. They block a substance called TNF that causes inflammation in the body. In many cases, your rheumatologist may start you on an anti-TNF drug first.

There are five FDA-approved anti-TNF drugs (Cimzia, Enbrel, Humira, Remicade, and Simponi). If the first doesn’t provide relief, your doctor may try one or two of the others. If the second or third anti-TNF drugs don’t work either, your doctor will most likely move you to another type of biologic.

Each of the other types of biologics targets a different substance in the body that causes inflammation. These biologics include Actemra, Kineret, Orencia, Rituxan, and Xeljanz. 

It may take a little trial and error to find the biologic that works best for your RA, but stay optimistic. Biologics, methotrexate, and other DMARDs are altering the course of rheumatoid arthritis for thousands of people with RA.

WebMD Medical Reference

Reviewed by Michael W. Smith, MD on July 01, 2013

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