Doing OK on MTX 1.0ml/week. MTX gives her severe fatigue. She was going to try a Biological but was going to have to get TB treatment (her dad had TB) and she gave up. Thoughts on Actemra ? vs. the other biologicals.
All the biologics require that patients first have latent TB (LTB) first treated. I would get a IGFR assay ( eg. Quantiferon Gold ) done to see if she has been exposed. If so, you can start Isoniazid for a month and then start your biologic. Enbrel may possibly be safer in that respect because it's not attacking membrane bound TNF. I use Actemra 3rd or 4th line because it has to be infused ie. I use it after Enbrel, Humira failure, and probably before I use Rituximab.
