Another nail in the coffin for the use of MTX for PsA

[mataribot]

While doing some research, I found a nice write up about PsA...

PsA Q4: In patients with psoriatic arthritis, is there a difference between biologic monotherapy and combination biologic-nonbiologic therapy in terms of efficacy, effectiveness, safety, or tolerability?

Recent evidence suggests that methotrexate is not efficacious and is not a DMARD in PsA (3 RCTs).

There is insufficient evidence to determine the efficacy and safety of biologic-nonbiologic combination therapy relative to biologic monotherapy.

Cited

Biologics for Psoriasis and Psoriatic Arthritis (Adalimumab, Etanercept, Golimumab, Infliximab, Ustekinumab) National PBM Criteria for Use – Monograph with Literature Review June 2013 VA Pharmacy Benefits Management Services, Medical Advisory Panel, and VISN Pharmacist Executives

[Caroline]

Hello Mataribot,

Indeed this seems to be correct..
I do not want to brag about is, but I already posted about a research on it. You can find it here
MTX senseless with PsA
You'll have to copy and paste, as linking is forbidden on the forum, but hopefully Fred will make it a true link, won't you Fred?  

Still derma and reumatologists insist on giving MTX as their first approach against PsA. It is very hard to change customs in medicine, apparently a very slow moving field.

Caroline

EDIT By Fred: Link made live.

[Fred]

https://psoriasisclub.org/showthread.php?tid=1354
You'll have to copy and paste, as linking is forbidden on the forum, but hopefully Fred will make it a true link, won't you Fred?  

Certainly will

If you or any member want an internal link made live just let me know, or better still hit the "Report" Button bottom right on the relevant post and it will take me straight there.

A couple of other similar threads you may also be interested in:
Methotrexate no better than Placebo for Psoriatic Arhtritis
Methotrexate not working for Synovitis in psoriatic arthritis

[mataribot]

Cool, you beat me to the punch. The site I found was a direct link to a pdf. I would never post that type of link.

I don't think rheumatology is slow here in the USA. It's all about the Benjamins. Insurance companies require three traditional DMARDs for at least three months before trying a biologic. There really isn't any thing to try that will work besides steriods. Some doctors get rather upset because some of there severe patients do not have access to good health insurance and have limited access to biologics. I have been yelled at several times about complaining about Stelara and my PsA. If it's not working for my PsA I have every right to seek different treatment.

[Fred]

If it's not working for my PsA I have every right to seek different treatment.

Yep, it's your body at the end of the day.

[Caroline]

If it's not working for my PsA I have every right to seek different treatment.

Yep, it's your body at the end of the day.

Indeed you are completely free to use the therapy you want. And you yourself are the expert to decide if some treatment does not work for you.

[Caroline]

Cool, you beat me to the punch. The site I found was a direct link to a pdf. I would never post that type of link.

I don't think rheumatology is slow here in the USA. It's all about the Benjamins. Insurance companies require three traditional DMARDs for at least three months before trying a biologic. There really isn't any thing to try that will work besides steriods. Some doctors get rather upset because some of there severe patients do not have access to good health insurance and have limited access to biologics. I have been yelled at several times about complaining about Stelara and my PsA. If it's not working for my PsA I have every right to seek different treatment.

Indeed I know that they, the insurance companies, first require at least three traditional DMARDs. But in the mean time more and more proof is coming out of the direction of a.o. rheumatology research, which suffers under the same rules, that this is not a smart way to go. First DMARDs appears to make the disease much worse thus causing higher cost for the insurer at a later stage, as then biologicals may work less well on the worsened disease.
With rheumatology it appears that a quick boost with a good working biochemical often reduces the seriousness of the disease, thus lowering the costs in a later stage, even sometimes leading to no treatment at all later on.
As both diseases are auto-immune diseases it is not illogical that this approach will also work with psoriasis.

Conclusion: rather stupid and in no-ones favor. Probably decided behind a desk in a little dark room....

[mataribot]

Cool, you beat me to the punch. The site I found was a direct link to a pdf. I would never post that type of link.

I don't think rheumatology is slow here in the USA. It's all about the Benjamins. Insurance companies require three traditional DMARDs for at least three months before trying a biologic. There really isn't any thing to try that will work besides steriods. Some doctors get rather upset because some of there severe patients do not have access to good health insurance and have limited access to biologics. I have been yelled at several times about complaining about Stelara and my PsA. If it's not working for my PsA I have every right to seek different treatment.

Indeed I know that they, the insurance companies, first require at least three traditional DMARDs. But in the mean time more and more proof is coming out of the direction of a.o. rheumatology research, which suffers under the same rules, that this is not a smart way to go. First DMARDs appears to make the disease much worse thus causing higher cost for the insurer at a later stage, as then biologicals may work less well on the worsened disease.
With rheumatology it appears that a quick boost with a good working biochemical often reduces the seriousness of the disease, thus lowering the costs in a later stage, even sometimes leading to no treatment at all later on.
As both diseases are auto-immune diseases it is not illogical that this approach will also work with psoriasis.

Conclusion: rather stupid and in no-ones favor. Probably decided behind a desk in a little dark room....

If I was treated aggressively from the first major onslaught of inverse I might not of progress into plaque and now possibly postulate. My inverse was miss diagnosed for as fungal infection for most my childhood. My hip and hand issues were in my head. Since I don't have five swallow tender joints, im going to have to beg my rhumey to exception the issue to try RA/PsA biologics (lot of paper work). Still two years away from DMF being released, and suppose to retail between 50 - 60k USD. /vomit

[Caroline]

Still two years away from DMF being released, and suppose to retail between 50 - 60k USD. /vomit

I think this is kind of criminal.
DMF is a very cheap basic substance. The way of creating a medication out of it is not very complex, as I suspect that their first release will be very basic, with all its accompanying problems.
The version we use over here is a subtle development over years, still the price is acceptable certainly given the results, therefore less additional problems.

Next to DMF there is an other alternative available, but I already mentioned that in another post.

[Krissie_Wright]

Before saying it's a nail in the coffin for MTX you really need to look at the immunological consequences of the other biological drugs available to treat PsA and deal with the patient responses regarding their success in treatment with the drug.

Personally I am loving it... I have next to no immunocompromisation and have not had a single issue with my PsA since starting on 10mg/week of MTX over a year ago.

Sure the potential side effects can be bad, but so can the side effects of many medications (paracetamol can cause liver damage) which can be bought over the counter.

I'll have a read through some of the research papers on the different biologicals and put together an "effects on the immune system and biochemistry" article and attempt to explain the side effects and pathways altered by the different drugs...

Personally, I believe anything that changes your biochemical processes leaving you potentially immunocompromised is never a great thing, but since PsA and PsO are immune diseases there is very little choice but to do this.

Krissie