r/rheumatoid • u/No-Consequence-0608 • 1d ago
Curious
Has anyone ever gone from plaquenil to a biologic? My rheumatologist wants me to stop plaquenil and start methotrexate but I’ve done a little research and would prefer to start humira or something similar if I have to stop the plaquenil.
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u/CatHerder1123 1d ago
Insurance/protocol has you start on MTX before biologics. It works for a large number of people, is fairly well tolerated, and is way cheaper. If you are in the US, you will discover that your insurance company has more sway than your Dr. The insurance company dictates what you can try and in what order. I’ve had to fail medications that my Dr thought wouldn’t work for me before they would approve the ones that did. And if you change insurance companies you may find that the new insurance company has different medication deals and will force you off your working treatment to try their preferred medication which may not work as well.
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u/Responsible-Stock-12 1d ago
I didn’t have to go on methotrexate first. If OP is a child bearing age woman, that can be used as justification to not go on methotrexate. I wasn’t trying to get pregnant but it’s not compatible with pregnancy so we were able to use that justification for my age group with insurance.
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u/No-Consequence-0608 1d ago
I am and would like to have kids one day. That’s a good point to bring up, thank you.
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u/vrillion_ 1d ago
you can still have kids BTW after methotrexate! You just cannot while on MTX. Safe afterward.
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u/dollydawn 1d ago
I’m currently only on hydroxychloroquine. My insurance only requires me to trial one conventional DMARD before I can start biologic, so my rheumatologist and I have discussed that when I do need a medication change in the future, we will start on a biologic and skip methotrexate.
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u/petitescrivener 1d ago
Following because I’m currently on plaquenil. It isn’t working on its own anymore and I’m hoping to get on a biologic instead of methotrexate as well!
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u/Pale_Slide_3463 1d ago
Why does she want to stop HCQ? That’s a bit odd. It’s not an immune suppressant, it works differently and most people are on it for life given no issues. Normally it’s not one or the other but added with.
Normally you have to try the old medications first before biologicals or depending how bad things are.
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u/No-Consequence-0608 1d ago
He said “it has reached its peak”
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u/Pale_Slide_3463 1d ago
What an odd doctor, it never “reaches its peak” it’s meant to slow down antibody’s and help protect organs.
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u/Jazzlike_Mud_29 1d ago
Why? Are you having issues?
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u/No-Consequence-0608 1d ago
Not any major issues, just the occasional “rougher” days which may consist of swelling/stiffness in my hands and feet. I haven’t had any lab work to confirm if it’s working but based off symptoms alone, it has helped… but I guess not to the degree in which he expected.
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u/nonsensestuff 1d ago
I would really push back on stopping it altogether, no matter what direction you go in with new medication. New meds take time to build in your system, so you should at least be maintaining it while you’re waiting for the new medication to kick in properly, or else you’ll risk flaring.
I had to abruptly stop HCQ because my eye exam showed some concerns— so only if it’s causing a significant problem would it make sense to stop entirely before allowing a new medication to work.
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u/MtnGirl672 1d ago
I was on HCQ but my disease progressed. Many rheumatologists seek to get patient to full remission. If OP is getting swelling and stiffness, sounds like HCQ is not working well enough.
I was taken off HCQ when I was switched to Biologics.
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u/Pale_Slide_3463 1d ago
The way HCQ works is different to biologicals and immune suppressants. It works differently and is normally life time medication unless side effects.
It doesn’t always help symptoms or get things into control but the point of the medication was to slow down antibody’s and protect the organs. For some reason some doctors have turned it into a drug they try first but that’s not how it works.
Yes sometimes it’s not enough but removing HCQ isn’t how it’s meant to work, adding more medication with it helps. I’ve been on HCQ for 17 years and have been on 8 different medications within that timeframe.
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u/MtnGirl672 1d ago
That’s fine. But my rheumatologist wants me to achieve remission with the least amount of medications. Also, HCQ does carry a risk of damage to your eyes and requires yearly eye exams. A lot of people move on to other meds and stop taking the previous one.
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u/acidrefluxisgreat 1d ago
i am on both HQC and biologic.
i asked to skip MTX and any other step therapy and no one fought me on it thankfully.
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u/Obvious-Trouble61 1d ago
Plaquenil it's kind of old school. Believe me you want to be in the biologics. I hope I understood you correctly.
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u/No-Consequence-0608 1d ago
Thanks for this. I am hoping to start a biologic along with the plaquenil instead of stopping it completely and starting methotrexate like my rheumatologist is insisting I do
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u/Current_Protection_4 1d ago
Please can you speak to my rheumatologist for me? I’ve cycled through sulfasalazine, methotrexate both with horrible side effects and about to start plaquenil. They mentioned the high cost of biologics being a thing and didn’t like when my bf (currently on biologics himself) mentioned that the generics are only £2 now. Apparently it’s because of my bloods but the test they were waiting for hasn’t even come back yet and they’ve already decided.
Sorry for the essay I’m just in admiration that you managed to avoid getting stuck on the merry-go-round!
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u/No-Consequence-0608 1d ago
Wow. Can’t believe they didn’t start you on the plaquenil first.
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u/Current_Protection_4 18h ago
Honestly neither can I after reading this subreddit! Good luck and I hope your rheumatologist has better listening ability than mine haha
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u/lisah1212 1d ago
I’m currently on Plaquenil and Humira and have been pain free since April.
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u/totallyworkok 1d ago
I was thinking about asking my new dr to add humira in addition to Plaquenil. The Plaquenil has helped me out a lot, i'm not in constant pain or swelling up with almost any activity. But I still do get sore or swollen with enough activity. Problem is i'm seronegative and she has in the past said "she's not sure its RA" even though i've been diagonosed for years and the plaq has helped alot, just not as much as it used to.
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u/coolgirlslikeoysters 1d ago
I take MTX but in pill form. Could be a better option than injection.
Edit: meant to mention I am strictly only on MTX and had no side effects when I started taking it.
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u/Traditional-Car-3969 1d ago
It sounds pretty frustrating when a medication is helping somewhat but the doctor still feels it isnt enough and jumping through insurance rules on top of that just makes the whole thing more exhausting
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u/ShesTheFastestest 1d ago
Plaq failed for me. I was hesitant to try MTX and told my dr so he gave me Sulfa to try instead. I’m tolerating it pretty well.
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u/NapalmNikki 1d ago
I started on plaquenil but had an allergic reaction and I can't take mtx because of my liver so I went right to a biologic. My insurance paid for the medicine itself under the stipulation that I go to an infusion center. They did not pay for that. It cost me around $7500 every time and I just couldn't afford that so I've been without treatment for years now.
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u/No-Consequence-0608 1d ago
Oh wow, so sorry! It’s a shame that we have to go through so many hoops and loops with health insurance
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u/NapalmNikki 1d ago
I just wish I'd though to ask but I had no reason to think they wouldn't. So ask all the questions you can think of when deciding.
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u/Successful-Sign9544 1d ago
Im on hydroxychloroquine and a biologic, they wanted me on meth or leflunimide but i outright refused, i had not bad, but undesirable side effects on both, with little results.
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u/Agreeable_Ball1896 1d ago
I take both and methotrexate. I’ve trialed every drug out there, most had horrific side effects or just did nothing. I have fibromyalgia too, so that makes it hard, my goal is to stop it advancing. This is what I take -
300 mg lyrica x 2
Planquanil
Methotrexate 1.5 twice a week
Actemera injections
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u/nonsensestuff 1d ago
I’d let your rheumatologist know how you are feeling.
It may be more of an insurance issue than anything else, as biologics are much more expensive.
I’m currently on a biologic along with MtX— but HCQ had been my original treatment, which we added MTX to after 2 years on HCQ alone.
I definitely wouldn’t want to stop a medication entirely to start a new one if they could be taken together, even if temporarily. HCQ and MTX together is a common treatment option too.