ArcaMax

DEAR DR. ROACH: I'm a 67-year-old healthy male, but I do take Humira for rheumatoid arthritis (RA). It does a wonderful job for me with no side effects. It does such a good job that I can periodically extend the time between injections, such as one every three weeks instead of the recommended dose every two weeks. I can even go as long as six months between injections without noticing much of the RA symptoms.

My rheumatologist is aware of this and encourages me to use the lesser amount if I still get relief. My quandary is that I was recently talking to my gastroenterologist about Humira, and he said that they use a very similar drug for gastrointestinal issues. But apparently, you aren't supposed to stop taking it consecutively because the body will become immune to the drug, and the drug can lose its effectiveness.

Naturally, I don't want to lose the great relief I am lucky to be getting, but I also know it's a strong drug. It seems the less I take of it, the better. -- J.C.

ANSWER: I share your gastroenterologist's concern. He may be thinking of a similar medication, vedolizumab (Entyvio). When this drug is stopped in someone with Crohn's disease, it will cause a flare-up of the disease in about half of the cases within six months. In a third of them, the medication will no longer be effective.

The situation is similar with adalimumab (Humira), as there is the possibility of a relapse if you stop it entirely. Taking it every three weeks led to a flare-up in 36% of people who had the disease well-controlled for years. The researchers were unable to identify any way to predict who would flare up. Restarting Humira regained control for over half of the study participants, but not everybody.

I do understand that these are powerful medicines with side effects. Even if you aren't noticing any, many people will, and there can be very serious side effects to many organs. Fortunately, these are uncommon, and in most cases, it is far better to stay on the medicine, as long as you are being monitored.

As a medical student, I remember seeing what RA looked like before we had effective medications, such as methotrexate and TNF inhibitors like Humira. Years of inflammation caused terrible hand deformities, mostly in the women I saw. Since you aren't having any side effects, and it is working well, I don't recommend the three-week dosing -- and certainly not six months between doses.

DR. ROACH WRITES: A recent column on hair loss and thyroid disease prompted many readers to write me with their experiences. One reader noted that increasing protein in their diet seemed to slow down hair loss and even cause some regrowth.

Another reader recommended biotin. I often recommend this as a trial, despite a lack of good evidence that it works. Biotin is a B-type vitamin that is very safe, although it can interfere with a lab assay on thyroid and other hormone levels.

I need to note that both hair loss and thyroid disease are very common, and it is not always the case that thyroid disease causes hair loss.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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