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Came across this – in the latest ACR 2008 recommendations on the use of DMARD's in http://www.rheumatology.org. It is the interval recommended for bloodwork to be taken when using non-biologic DMARDs for RA. I thought the recommendations for minocycline were the most interesting. Seemed to me to underscore its relative benign-ness. May be useful for those attempting to persuade their doc to prescribe it. I have saved this page as a pdf – may also be useful for some to look at the site and the recommendations in total.Lynnie
Be well! Lynnie
Palindromic RA 30 yrs (Chronic Lyme?)
Mino 2003-2008 100mg MWF - can no longer tolerate any tetracyclines
rotating abx protocol now. From Sep 2018 MWF - a.m. Augmentin Duo 440mg + 150mg Biaxsig (roxithromycin). p.m. Cefaclor (375mg) + Klacid 125mg + LDN 3mg + Annual Clindy IV's
Diet: no gluten, dairy, sulphites, low salicylates
Supps: 600mg N-AC BID, 1000mg Vit C, P5P 40mg, zinc picolinate 60mg, Lithium orotate 20mg, Magnesium Oil, Bio-identical hormones (DHEA + Prog + Estrog)Thanks Lynnie for sharing. I find it interesting that hydroxychloroquine (generic for Plaquenil) also seems relatively harmless in terms of bloodwork follow-up but actually, one needs to have eyes checked while taking it. I was told every 6 months when I first started taking it, but I think I recently saw a once a year recommendation – maybe by ACR.
I read the whole PDF on the ACR website, and it makes no mention of follow-up bloodwork for biologics. I wonder why?
Yes Joe, interesting. I could not find a reason for non-mention of lab intervals for biologics either. Yet the whole article is on both. Lynnie
Be well! Lynnie
Palindromic RA 30 yrs (Chronic Lyme?)
Mino 2003-2008 100mg MWF - can no longer tolerate any tetracyclines
rotating abx protocol now. From Sep 2018 MWF - a.m. Augmentin Duo 440mg + 150mg Biaxsig (roxithromycin). p.m. Cefaclor (375mg) + Klacid 125mg + LDN 3mg + Annual Clindy IV's
Diet: no gluten, dairy, sulphites, low salicylates
Supps: 600mg N-AC BID, 1000mg Vit C, P5P 40mg, zinc picolinate 60mg, Lithium orotate 20mg, Magnesium Oil, Bio-identical hormones (DHEA + Prog + Estrog)Because they assume you are also on a DMARD that would need labs? Mtx does the heavy-lifting in every biologic study I've ever seen.
Mom of teen daughter with Poly JIA since age 2. Current med: azithromycin 250 mg MWF.
Suzanne, may I ask what you mean? By “heavy lifting” are you saying that with a MTX/Biologic combo that the main benefit is derived from MTX? Biologic monotherapy is becoming more common, and some studies show it to be as effective as MTX/Biologic combo. Biologic therapy is usually only initiated after an inadequate response to MTX anyway. It is true that MTX is still considered the gold standard of treatment.
That is exactly what I am saying. That is my opinion, based on studies I have seen. There is a biologic study that shows a certain biologic works the same as a placebo in children.
Mom of teen daughter with Poly JIA since age 2. Current med: azithromycin 250 mg MWF.
My opinion is also that once the biologic is added to the mtx, suddenly there is perceived to be an adequate response, whether things really changed or not. ACR20, ACR50, ACR70. None of that is remission, is it?
I'm feeling very opinionated today LOL.
Mom of teen daughter with Poly JIA since age 2. Current med: azithromycin 250 mg MWF.
[user=18]Suzanne[/user] wrote:
My opinion is also that once the biologic is added to the mtx, suddenly there is perceived to be an adequate response, whether things really changed or not. ACR20, ACR50, ACR70. None of that is remission, is it?
I'm feeling very opinionated today LOL.
That's the great thing about double-blind studies. Perception plays no part because the biologic being studied is compared against controls to eliminate the placebo effect. I don't know the specifics of what ACR20, ACR50, and ACR70 are – but I do know what clinical remission is because I see it every day.
Nothing wrong with having opinions!
http://www.druglib.com/abstract/ru/ruperto-n_arthritis-rheum_20070900.html
Mom of teen daughter with Poly JIA since age 2. Current med: azithromycin 250 mg MWF.
Another peds study. 10 patients. One death. Symptoms came back in others. But they still conclude there is some benefit.
Mom of teen daughter with Poly JIA since age 2. Current med: azithromycin 250 mg MWF.
[user=18]Suzanne[/user] wrote:
http://www.druglib.com/abstract/ru/ruperto-n_arthritis-rheum_20070900.html
CONCLUSION: While infliximab at 3 mg/kg and 6 mg/kg showed durable efficacy at 1 year, achievement of the primary efficacy end point at 3 months did not differ significantly between infliximab-treated and placebo-treated patients. Safety data indicated that the 6-mg/kg dose may provide a more favorable risk/benefit profile. These results warrant further investigation in children with JRA.
My comments: “Durable efficacy at 1 year” – not at three months – so it took a while for it to kick in.
[user=18]Suzanne[/user] wrote:
Another peds study. 10 patients. One death. Symptoms came back in others. But they still conclude there is some benefit.
CONCLUSIONS: Rituximab had an acceptable toxicity profile in this group of patients with severe, refractory autoimmune diseases, although there were three serious infections and one patient death. Rituximab appears to be beneficial for patients with refractory autoimmune diseases and may reduce corticosteroid exposure. Although rituximab therapy provided a durable clinical benefit for some patients in this population, other patients had reemergence of their underlying autoimmune disease.
My Comments – Rituximab is not an anti-TNF biologic, it is a B Cell inhibitor from the cancer world. Still “beneficial for patients with refractory autoimmune diseases”…
[user=20]Joe M[/user] wrote:
[user=18]Suzanne[/user] wrote:
http://www.druglib.com/abstract/ru/ruperto-n_arthritis-rheum_20070900.html
CONCLUSION: While infliximab at 3 mg/kg and 6 mg/kg showed durable efficacy at 1 year, achievement of the primary efficacy end point at 3 months did not differ significantly between infliximab-treated and placebo-treated patients. Safety data indicated that the 6-mg/kg dose may provide a more favorable risk/benefit profile. These results warrant further investigation in children with JRA.
My comments: “Durable efficacy at 1 year” – not at three months – so it took a while for it to kick in.
Joe, they stopped the placebo at 14 weeks. Maybe it would have kicked in a year, too. Guess we'll never know. According to our ped rheum, they had “a really good placebo.”
Mom of teen daughter with Poly JIA since age 2. Current med: azithromycin 250 mg MWF.
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