Question
Is it appropriate for a doctor to withhold biologics and cite “cost to society” as the reason? I am watching a loved one go downhill (increased number of swollen joints, increased fatigue, malaise and overall pain). Yet the only reason she gives is “cost to society”. Wow, does that ever seem like a terrible thing to anyone, especially someone who is sick.
Answer
Our stance on this at the Hopkins Arthritis Center is the following: We start treatment with a non-biologic (oral) drug first – usually methotrexate – because it has a long track record of safety, it is as effective or nearly as effective as the biologics, and it is cheaper than biologics. However, if the patient cannot take methotrexate because of liver problems, OR if the patient takes methotrexate but doesn’t get an adequate enough response, then YES we proceed to the biologics like Enbrel. Certainly, folks who have bad disease should get access to the biologic drugs no matter what. However, as physicians we should be fiscally responsible and not start these drugs as first line treatment unless there are extenuating circumstances. In general, they should be second line drugs.
