From Gold Injections to Biologics: A Patient's 21-Year Battle with Rheumatoid Arthritis

Throughout many years of injections, pain, and treatment failures, Mary Sanchez has accomplished the difficult feat of staying positive and remaining hopeful that a newly-approved medication could effectively treat her rheumatoid arthritis (RA).

Sanchez was first diagnosed in 1996, soon after she had her first child. Before having her children, she did not experience significant symptoms of RA.

“I had some joint swelling, but they did blood tests when I was 27, and it never came up with inflammation,” Sanchez told Specialty Pharmacy Times. “They said ‘you probably don’t have rheumatoid arthritis. It would show in your bloodwork.’ After I had my daughter, they did a blood test for inflammation, and it showed positive that I had rheumatoid arthritis.”

For any new mother in her late 20s, a diagnosis for any condition can be overwhelming.

“I was terrified, but they told me at the time there were lots of options, and I was very young so they should be able to help me with the medications,” Mary told SPT. “So, they created a treatment plan, and we started treatment.”

Mary was initially administered gold injections, which may sound strange , but has actually been around for several decades as a therapeutic approach. This treatment has been found to effectively treat RA symptoms, and can also prevent joint damage and associated disabilities. However, little is currently known about how these treatments work in the body to relieve symptoms.

“In the 90s, I don’t think they had biologic drugs. I was getting injections of gold, the mineral. They would give me a shot of it suspended in liquid,” Sanchez said. “I’m not joking, but that lasted for 6 months. Then they tried methotrexate, which I still take to this day. Then, I did not get the gold injections, and the methotrexate worked for 7 to 10 years. When that wasn’t enough, we moved to Enbrel, which also worked for 7 years.”

In 1996, when Sanchez was first diagnosed, there were only 3 treatment options, with the combination of gold injections and methotrexate serving as her treatment regimen.

Since her initial diagnosis, Sanchez has been treated with many different drugs. Notably, she received treatment with the biologic drug Enbrel (etanercept), which was the most effective option for her.

“I took Enbrel for 7 years, and it worked beautifully until March 2015,” she said. “It stopped working. Up until then, all the medications worked, and I had no problem. That’s when I had to take new medicine.”

With Enbrel no longer working, Sanchez essentially had to start over. She also went on to experience her first and only treatment barrier from her insurance plan. Sanchez’s physician said that Orencia (abatacept) should be the next treatment she tried, but her insurance company refused.

“The insurance company sent me a letter saying there were these approved treatments that I had to try for 6 months each before they would give me Orencia,” she noted. “So, I had to try 2 drugs for 6 months, and when they didn’t work, they didn’t make me try the third. They let me get Orencia, which I have been on since last April.”

The approach, known as step therapy, is a common practice insurance companies implement to lower costs, especially for costly drugs such as the biologics used to treat RA. Sanchez recounted how frustrating this process was for her.

“That was very frustrating, because my doctor thought the Orencia would work. He gave me a few samples, and I thought it was working,” she said. “So, if I know this one works, and the doctor thinks it’s the right one, why do I have to go through trying what you [the insurance company] think? Unfortunately, the doctor tried to appeal, but they replied that I had to try the approved therapies. That was very annoying to me, because once I knew it didn’t work after 3 months, I knew I was just killing time until September when I could try a new medicine. I wasn’t as hopeful at that time.”

Like many patients who are required to try other treatments before receiving coverage for a specific drug, Mary felt that her physician, who knows her condition best, should be the one to make her treatment decisions instead of insurance companies.

However, despite this challenge, Sanchez never experienced any other treatment barriers.

Currently, Sanchez is confronted with the difficulty of resistance to Orencia. When she was on Enbrel, she had relatively few symptoms. But she has begun to experience pain, and is seeking treatment with other drugs, such as prednisone to combat swelling.

“That was the only thing that helped the swelling on some of my joints. Since then, I get some relief, but not the relief I have felt. When I was on Enbrel, I didn’t really have to take any inflammatory drugs, but now I take them every day.”

Despite these struggles, Sanchez has stayed hopeful, and will begin treatment with Xeljanz (tofacitinib) very soon.

Since treatment options for RA keep growing and improving, Sanchez is confident that she will find a drug that will provide the same amount of symptom control as Enbrel. She said that staying positive is extremely important, especially since finding the optimal treatment approach for RA is difficult.

“I think that because they have so many options, I have to keep going. Although I have some joint pain and joint damage, I feel like I have to keep going,” Sanchez said. “I’m very excited to start [Xeljanz]. I’m a positive person. You have to have positivity. Someone always has it worse than you, in everything. You have to suck it up and not be miserable.”