Kickas.org Forums Treatments, Drugs and Alternatives Anti TNF and other biological medications Criteria for Anti TNF medications

I am newly diagnosed and I have lower back pain.

I was wondering what the criteria is for being diagnosed Anti TNF drugs?

In the UK there is a lot of bad press about patients not being given various drugs due to the cost. I don't want to be fobbed off and told I don't need any drugs, if it is really about the cost.

Do Rheumatologists look for example to see if there is any fusing before they prescribe the drugs? Would they rather you didn't take the drugs due to the possible side effects?

Thanks for any answers you can give.

Michelle

Im in Canada and I am on Remicade. I was lucky enough to get involved in a study group. I have no fusion and was accepted anyway. The criteria usually involves trying pretty much all NSAIDS and DMARDS and if no positive results occur (symptom wise) you are usually accepted for anti-TNF treatment. This was the case for me and I believe for most here on KA.
Good Luck Michelle, Scotty...

Hi Michelle,

The criteria can be quite different from one healthcare system to the next, and many countries are still in the process of developing/changing their criteria, I believe. For some, the criteria is based on the severity, and level of disease activity factored together with types of meds that have been trialed unsuccessfully... but even then access may be restricted due to the sky high costs.

I live in the same location as Scotty, so am lucky to have access to these incredibly expensive meds. I wish these meds were available to every ASer who wished to try them. I think currently in the UK it's extremely difficult to gain access, tho hopefully this will change in future.

My best to you!
mig

Hi Michelle,
Another Canuck here like Scotty and Mig. I'm on Enbrel though, not remicade.
My fantastic rheumy managed to get me into a program to cover Enbrel, but I had to show that I tried every other possible medication without success. I was also no longer able to work or go to school...or move, for that matter. And I also had some impressive looking MRIs to back up my case. This process took years, unfortuately. I think it helped having a rheumy who is a teaching physician, who has alot of pull in a major city teaching hospital, and knows the ins and outs of the health care system/drug programs very well. Hopefully you'll find a rheumy who is supportive and willing to go to bat for you. Good luck!

Hi there, I'm in the same area of Canada as Scotty and Mig. Actually, we all three share doctors in common to a degree.

Alot of people are being offered these drugs upon diagnosis. 'Alot' is subjective, of course. However, I am also on Remicade - fused left SI, squared off thoracics, pain, pain, pain. My rheumy based his decision to put me on it on the fact that AS has impacted my life severely - not on how severe my actual disease is.

See if you can get in at the Bath Institute. The Head there is extremely good and may be able to help you get on it. Somehow. Not sure how or even if she can, but she's worth a try.

Good luck.

Hugs,

Hi Michelle,

I came across the below article just the other day; it doesn't quite answer your questions but is useful all the same.

UK AS article

My boyfriend has AS and it would be amazing if he was able to get on an anti-TNF. Unfortunately he's been waiting for forever to see a Rheumatologist, and until he sees one can't get on a clinical trial or find out whether our Primary Care Trust will fund the drug. Which is a bit of a bummer because there are currently some perfect trials running that are recruiting patients (provided the Clinical Trials website is in fact up to date).

Clinical Trials

Gillian

my insurance lists the criteria for the Enbrel... one criteria is that i failed to improve with methotrexate and sulfasalazine, and that there was substantial pain. Hopefully you can link to your insurance company's web site and find the criteria for when they will pay for a medicene.

good luck
e