When Treatments Don't Work or Stop Working

Taking medications has been compared to a roll of the dice. Not that much of a gamble really, but the point is you don't know what response you will get until you're actually using the medication.

Response to medication is individual. There are no guarantees, but just as there are side effects that may be anticipated, there are expected therapeutic responses. You must allow sufficient time to achieve the desired therapeutic effect. If you give up too soon, you may prematurely give up on a drug you shouldn't give up on. If you wait too long, you are wasting time better spent on initiating another medication or treatment.

Essential

Under the direction of your doctor, you should stay on a drug for a sufficient amount of time to judge its therapeutic effectiveness. When you should change depends on the drug you are taking. For example, if you do not respond to the first TNF (tumor necrosis factor) blocker after three months, switching to another will increase the chance of benefit. Even if you fail two of three TNF blockers, the third may be effective.

DMARDs (disease-modifying anti-rheumatic drugs) are slow acting and can take from one to six months to work. The biologics which includes TNF blockers may be effective in days or weeks (most often within the first month, but may take longer). Results, however, vary with the individual patient. Your individual response may be slower or faster than another patient who is receiving the same drug at the same dose.

Many patients become quite frustrated when they experience no improvement with their prescribed medication or if improvement isn't quickly apparent. It really can be a long process to find the right drug, and you may face many failed attempts before you find the right combination of drugs. Keep in mind that this is normal — most arthritis patients have failed attempts and try several drugs.

Question

What should you do after giving a medication sufficient time?

First, under the direction of your doctor, change the dose of your medication to try and elicit a better response. Second, try other drugs within the same class, if changing the dose didn't help. Third, try a drug from a different class of arthritis drugs. Finally, never give up.

Medications can be ineffective from the start or can become ineffective after being used for a period of time. Retreatment is a possibility in some situations. A study published in Arthritis Research & Therapy revealed that half of the study participants who used methotrexate, the most commonly prescribed DMARD for rheumatoid arthritis, found it to be ineffective at one point in the course of their treatment but benefited from the drug after being treated a second time. The finding was especially true for patients who had received a low dose during the first course of treatment with methotrexate.

However, if the biologic drug Remicade is discontinued and later restarted, there is a chance of allergic reaction. Retreatment with Remicade has caused rash, fatigue, fever, liver abnormalities, and, rarely, life-threatening allergic reactions.

Medications are just one form of arthritis treatment. Medications used in combination or medications used along with complementary treatments may elicit a better response than any single treatment used alone. If nothing seems to be working and sufficient time has been allowed, reconsider your many treatment options.

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