What makes doctors prescribe certain medications/treatments over others

[cheeky]

hey.. .

so i'm chillin at home, waiting to go to an appointment for my very first remicade infusion...

and i've been reading a bit. and thinking.

i've wondered this before but curious to see if anyone here may have some insight.

i'm wondering what makes doctors decide to prescribe certain medications/treatments over others?


for example, why would someone be put on remicade instead of humira? or other steroids instead of prednisone?

is there a difference in strength? is it just the doctor's personal preference or what they feel more knowledgeable about?

or do they just decide based on certain similarities in symptoms and pick the treatment that worked well for others with the same pattern of symptoms?


i guess none of us can know for sure... but maybe someone knows a bit.

 

[Cookie]

Good question, Cheeky. I think you hit the nail on the head with all three of those options...I think it's a combo of a lot of things. I know for a fact that when my doc first put me on Remicade, he was not very familiar with Humira and was way more comfortable with the Remi because he had seen results. When he suggested Humira, he said that it was a similar option, but some people respond to one over the other. I think it's a little bit of trial and error, but most doc's probably have a set "pattern" of options that they try, which may vary from patient to patient depending on their symptoms.

 

[NatalieMT]

I strongly believe here in the UK certain medications are given over others due to the level of cost it incurs the NHS. They usually start with the cheapest option if it's deemed suitable from experience.

That's why I personally prefer the way the US healthcare system works or go private if I can. Lately I'm really fed up of the NHS.

 

[shazamataz]

Yup, in New Zealand it's public health, which is great in a lot of ways, but it does all boil down to cost. Prednisone is VERY cheap, Entocort is expensive, so they don't give it to you and pred is first choice.

There was an article in the paper recently about the local health board considering approving the use of Humira for severe cases of Crohns. It has been used in the rest of the country but not here due to funding as it costs about 25 grand a year.

I am interested that so many iof you lot are on Remi or Humira, sounds like they aren't using it much here except in severe cases.

 

[CrohnieCarolyn]

My doctor gave me the option of Remicade or Humira... I opted for the Remicade...I am now on Cimza and have to stab myself afterall...but I didn't get the impression it was about money - more like what I would be comfortable with - but I have good insurance luckily..

 

[cheeky]

I agree. My doc is in a group of GI docs at a local university hospital. I think they have a set standard of prescribing meds based on the severity of the Crohn's each patient has. I'm thinking there is probably a standard for the US for what they call a bottom up approach. I recently attended this IBD conference and all the docs from my university presented different things - and they had a doc from up North present as well. The doc from up North put up a slide that showed the bottom up approach of drugs - and every step is exactly how I had been prescribed meds over the last 13 years. So, in a way - I know what my next "options" are if Remi every fails me based on that model.

I don't know where you are from Cheeky - but I have noticed that things are different in Canada and definitely different in the UK and Europe after being on this forum for a while. Sometimes I scratch my head.......

I'm also wondering if they choose Remi first before Humira since I think people are less likely to have reactions to Humira - and they may want to save that for if you have a reaction to Remi or if you fail Remi at some point. This may change over time as Humira is more widely used - they may prescribe it first. And as always - neither one works for every person. And I won't be naive and not tell you that some docs may be motivated to give you Remi if it is infused in their office as they will end up with a cut of the profits from it - where as if you get Humira - you pick that up at your pharmacy - and they get nothing. Don't think too much about that...but I am sure it is a reality.

Wishing you a good and event free infusion - let us know how it goes!!!

I'm in Canada (Toronto)

Yes, I was wondering that too Shantel... there maybe a relationship with certain pharmaceutical companies who represent Remi.

my infusion went well thanks... except, even though i drank a ton of water, it took them 30 minutes to find a vein... they couldn't even get one in my hand until the last minute... stuck my left hand.

i felt very slightly drowsy while getting the remi, but completely fine after... i thought i'd pass out right away... but i fell asleep at a reasonable hour... i think lol.

the nurse said usually the first infusion is fine but by the time you get into infusion 2 or 3 you may feel something more since the antibodies begin to develop or something like that.

however, i'm just concerned about Imuran and would like to quit it. im getting rashes all over my neck (also itchy skin and whiteheads on my face), i have breathing problems (tightness in the chest, shortness of breath), i've started snoring, and i get cold like symptoms often... and i don't like the fact that i will be at higher risk for lymphoma pairing imuran with remi (plus cancer is in both sides of my family) AND having to get blood work every month is torture with my veins... i'm developing scar tissue in my vein area so it's getting worse trying to get blood. oh yeah and last night, i was getting some lower back pain... imuran or remi? who knows but i'm thinkin imuran.

i tried calling my GI a couple times... left a msg for him to return my call regarding the imuran, but haven't heard back yet.

 

[cheeky]

My doctor gave me the option of Remicade or Humira...since I didn't want to stab myself with a needle I opted for the Remicade...I am now on Cimza and have to stab myself afterall...but I didn't get the impression it was about money - more like what I would be comfortable with - but I have good insurance luckily..

yeesh, i couldn't imagine trying to stab myself lol.

 

[boydman]

i would hope that money or the cost of any treatment would not be a factor for any doctor, but who can be sure. i believe they start you out with the least aggressive to see if it works or until you build an immunity to it and upgrade from there

 

[cheeky]

Don't listen to that nurse!! You have the *possibility* of having issues on the 2nd or 3rd - but it is no guarantee! I hate when they set people up like that - it can give you complete anxiety for NOTHING. I have had over 30 infusions - and have been fine every time.

I was on methotrexate at the beginning of my Remi. After about 6 months they let me quit taking it as it was just making me so sick. The reason they pair them is it is less likely that you will develop a reaction to the Remi on the Imuran - therefore lengthening your ability to be on it. Your health is your choice - you will want to wait at least 3 infusion cycles I imagine to make sure the Remi is going to do the trick for you. Then you can see if you can come off the Imuran. I wouldn't do it before then in case you need to switch to something else. Remember - that Imuran took a while to kick in right? They wouldn't want to leave you with no coverage if the Remi didn't work for you.

I can't remember if you were part of the "veins" thread or not - people gave some good advice on how to get those IV's in.

Good luck with the next infusion....hope it works for you!

thanks Shantel! yeah i'm too scared to stop the imuran without my GI's 'permission' for lack of a better word lol...

and yes, i was in the thread that mentioned veins... i'm going to try the heating pad next time... the water made absolutely no difference.

they think it's also scar tissue that's causing the added difficulty...plus my grandma says i got the tiny veins from her lol... thanks grandma!