Switching from a biologic to a biosimilar – Jane Scarfe outlines her experience
I was diagnosed with rheumatoid arthritis when I was 48 years old. I had shooting pains in my right arm and terrible fatigue. My GP was brilliant, performing blood tests, then immediately referring me to a rheumatologist at the Norfolk and Norwich University Hospitals NHS Foundation Trust, where the care is excellent.
I am one of the lucky ones as my early diagnosis is not always the case in people with rheumatoid arthritis.
The rheumatology unit was ahead of its time in that my consultant said we were going to “hit it hard and hit it fast”. He believed if the rheumatoid arthritis proved to be not aggressive we could always reduce my treatment, but until then, we would go for it with all guns blazing as the worst damage usually happens in the first three months.
Initially I was put on sulfasalazine, which is a disease-modifying anti-rheumatic drug (DMARD) along with methotrexate and anti-inflammatories. Despite a few ups and downs, my treatment worked well until 2009 when I had a massive flare-up.
My Disease Activity Score met the criteria for biologic therapy and I was put on infliximab. It changed my life, and I was pretty much back to normal.
When I was told my medication would change from a biologic (infliximab) to a biosimilar (first Inflectra and then Remsima) I didn’t fight it but I did ask a lot of questions. I was well informed through letters and face to face meetings with the biologic nurse practitioner.
Unfortunately, within a couple of days of being on the biosimilar I felt it wasn’t going well, and soon after that, all my joints flared up. I developed nodules I had never had before. I was the most ill I’d been since diagnosis.
My consultant could see I was having a bad reaction to the new medication and had to go before a committee to ask if I could go back on infliximab. They agreed and within a short period of time being back on infliximab my rheumatoid arthritis was under control again.
We cannot underestimate the financial pressure the NHS is under and biosimilars offer a huge saving for the NHS. To anyone informed that their medication is being switched I would say, do not be alarmed at my experiences. However, ask your rheumatology unit these questions: how many people have they switched; how many people have had a bad reaction; and if you have a bad reaction, how easy is it to switch back?
People with rheumatoid arthritis know how much money they are costing the NHS. It is absolutely right that we receive the care and comfort that we need but we need to work with the NHS to ensure it is as affordable as possible.
Jane Scarfe is chair of the Rheumatoid in Norfolk group and a public governor at the Norfolk and Norwich University Hospitals Foundation Trust. Visit www.thering.org.uk for more information.
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