Weighing Your RA Medication Risks and Benefits
What you need to know about the drugs prescribed for your rheumatoid arthritis.
When your doctor says you need a new medication, do you nod and accept the verdict? Or do you ask, “Why do I need this? Will the benefits outweigh the risks?” Decades ago, the latter response was uncommon, but that’s changing. An increasing number of doctors welcome patients to share in decision making.
“A treatment plan is much more likely to succeed if the patient is a partner, instead of the doctor being a dictator and saying, ‘This is what you’re going to do,’” says Rebecca Manno, MD, a rheumatologist at the Johns Hopkins Arthritis Center in Baltimore. But pulling your weight as an equal partner means making sense of the morass of information about medications available. The more you understand, the better you are able to ask the right questions and make informed decisions that reflect your preferences and values.
Imagine you read that the U.S. Food and Drug Administration (FDA) has approved a new drug. Most people believe “safe and effective” means the FDA only approves “extremely effective” drugs and doesn’t approve drugs that can cause serious side effects. But those assumptions aren’t true. So what does a stamp of approval from the nation’s drug overseer really say about a new medication?
“It means the FDA has judged that a drug’s benefits outweigh the risks,” says Lisa Schwartz, MD, a general internist and co-director of the Center for Medicine and Media at The Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, New Hampshire.
So, don’t assume that a newly approved medicine that you see in a lot of commercials is better than your current treatment. “Some approved drugs are only marginally effective and don’t have a big effect on how you feel,” says Dr. Schwartz, who studies ways to improve the delivery of information about medications to patients.
Getting a complete understanding of a medication’s potential benefits and risks during a TV commercial is challenging. The FDA requires advertisements for prescription drugs to be accurate and to balance information about a drug’s risks and benefits, which is difficult to accomplish in 30 or 60 seconds. The agency reviews advertisements before they air to ensure companies don’t present false or misleading information. Of the nearly 100,000 promotional pieces reviewed each year, only a handful receive warnings from the FDA before airing.
Still, you should not rely on TV commercials to give you the full picture about a drug’s risks and benefits. “If you want to know whether a drug is right for you, work with your prescribing physician and pharmacist,” says Mohamed Jalloh, PharmD, and assistant professor at Touro University California College of Pharmacy in Napa, and a spokesperson for the American Pharmacists Association.
Pharmaceutical ads rarely include hard data, but the news media often touts statistics when describing a drug’s benefits and risks. And when they do, the numbers cited are almost always expressed in relative terms, which can sometimes exaggerate the likelihood a medication will help or harm you.
Imagine a study with two groups of 100 RA patients. Group one is given Drug X, while the other gets a sugar pill. After one year, four patients in group one developed a serious infection, compared to two patients in group two. A news item about the study might say the drug increased the risk for infections by 50 percent. Sounds scary. Yet, in absolute terms, the drug increased the risk for infection by just two percentage points. That’s concerning, but perhaps not enough to dissuade you from taking a medicine that could ease your symptoms.
The Medication Guide
With each new prescription, your pharmacist hands you a medication guide along with the medicine. If you take time to read it – and you should – you may be alarmed by the scary warnings. For instance, medication guides for biologic drugs state the medicines may increase the risk for some types of cancer. This may cause you to freak out, when in fact, the risk that a biologic will cause cancer is quite low, notes Susan Blalock, MPH, PhD, a behavioral scientist at the University of North Carolina’s Eshelman School of Pharmacy.
Keep in mind that medication guides “are really written for lawyers,” says Blalock, who studies ways to improve RA patients’ ability to understand the medications they’re prescribed. She explains the text is written to safeguard pharmaceutical companies against lawsuits in the event a patient develops side effects.
Use Reliable Sources
“I encourage patients not to rely on Dr. Google,” says Dr. Manno. The internet is an unregulated bazaar of medical information, and much of it is biased, misleading or flat-out wrong, she notes. Instead of typing the name of a medication into a search engine, advises Dr. Manno, learn more about meds that may help your RA by going directly to a reliable source, such as the website of the Arthritis Foundation, an academic medical center or the National Institutes of Health.
Doctors remain the primary source of information about medications for most patients, notes Blalock. But getting all the facts you need may take some prodding. Blalock and her colleagues audiotaped more than 1,000 office visits involving RA patients and their rheumatologists. Their 2015 study in Arthritis Care & Research found that rheumatologists who prescribed new medications brought up the probability of side effects only about 30 percent of the time. So if your doctor doesn’t mention side effects, it’s imperative that you do.
Complete candor is one of the most important tools you can bring to the conversation over medications. “Be as specific and honest as possible. Tell the doctor what you’re concerned about,” says Dr. Manno, “because he or she can’t guess.”