Effectiveness of treatment and insurance issues?

Question 

Kindly answer the following questions
1-I have taken 2 in infusions of remicade, third loading dose which was to be a month apart after second dose has been delayed due to an infection. I have no relief. I have problems with my insurance company, as they do not believe that the medicine is not affective on me. Are there tests which can indicate the affectivness of remicade

2-Secondly what alternate medicines are avilable, incase remicade does not continue to be affective, 3-Also please let me know if remicade works for me, will I have to stay on it LIFE LONG or at some point on can be off this drug, as I plan to move out of my present country of residence in few years and country I plan to go I would not be able to afford this medicine.

 
Answer  These are good questions.  Increasingly, insurers are requiring proof that biologic drugs are working.  There are scoring methods for RA disease activity designed for use in clinical trials.  They are called the DAS and the ACR response criteria, and are a score calculated from the combination of the number of swollen and tender joints, pain questionaires and inflammatory markers in the blood (ESR and CRP).  Drugs like Remicade, Enbrel and Humira often need to be continued indefinitely as long as the RA remains active.  Since RA is considered a chronic disease, this could potentially mean life-long.  The traditional DMARDs, methotrexate, hydroxychloroquine, sulfasalazine, leflunomide might be used alone or in combination in place of the biologic agents.

Last update: 10:53 AM Wednesday, August 1, 2007

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Alan Matsumoto, M.D.

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