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Just a tangential headsup for others if they are paying for vimovo (out of pocket, or significant co-pay).

Vimovo is a combination of two generics (naproxen & esomeprezol) delayed release. You can probably get OTC versions of the two pills for much cheaper than what Vimovo charges.

This drug falls into (IMO) ethically grey area in terms of drug pricing & marketing; on the one hand, it is (was?) priced much higher than the individual generics that are part of the combination; on the other hand, it is a convenience.

Horizon pharma, which markets the drug, is not the cleanest of the bunch either [1,2] .. They have a really good understanding of the healthcare market, and know exactly how to game it.

[1] https://www.bloomberg.com/news/features/2018-04-06/when-thes...

[2] https://www.forbes.com/sites/johnlamattina/2018/03/15/physic...

(edit: added 2nd link)

Naproxen (anti-inflammatory) isn't the kind of thing that you want to be on long-term, if it can be avoided, either. I have just been diagnosed with autoimmune psoriatic arthritis. I had three months of Naproxen, which made it possible to walk a couple of miles each day, but they were basically handed out as a "Here, this should take down the inflammation, now wait for your specialist appointment."

Having said that, I'm not sure Naproxen is any worse than the Prednisolone (steroid) tablets I'm now on for two months while I wait for the Methotrexate (nasty cytotoxic) to work.

If there's a stem cell treatment on the horizon, I'd love to hear about it.

Naproxen is vastly superior to prednisone.

The side effects from prednisone are wretched, and long term use is way worse than the impact of naproxen.

I was on nsaids for a decade due to poorly constructed skeleton. I only moved off because I became tolerant to them.

Agreed. I think Predisolone is probably a bit better than Prednisone too. Yes, the side-effects of Naproxen were not as bad, but I'm only on Prednisolone for 8 weeks. I wouldn't want it for longer, given how sick it's making me feel right now. Thing is, it is being way more effective on the first dose than Naproxen ever was.

Naproxen can restrict blood flow to the kidneys so need to be cautious in the long term.

Yeah, but compared to prednisone it's water :)

The NSAIDs are all remarkably safe, as opposed to steroids, and the non-steroidal non-NSAIDs (wtf thought it was good to make NSAID mean just a specific group??).

I'm on Celebrex, which is much more exciting in its side effect profile, but is still preferable to prednisone :-/

Has your doctor talked about Otezla (aprimelast) or biologics?

Otezla inhibits PDE4, an enzyme which regulates pro-inflammatory cytokines, and has the benefit of being an oral medication; one tablet a day. Biologics such as Humira and Stelara are more potent and even more targeted, but need to be injected.

What Otezla and biologics have in common is that they're much more narrowly targeted to the immune pathways of PsA/PsO than older systemic treatments such as prednisolone, methotrexate, cyclosporine, etc.

Thanks for the info. It looks like I only get Otezla if Methotrexate fails to work, or I pay a lot.

You may want to look into Taltz. It has really helped me, and practically no side effects aside from some injection site reactions.

If your insurance won't cover it (mine wouldn't without trying older ones with way worse potential side effects) the drug company offers a program that only requires a $25 copay.

> You can probably get OTC versions of the two pills for much cheaper than what Vimovo charges.

I don't think you can, specifically:

I don't think naproxen (as distinct from naproxen sodium, which has more rapid effect) is available OTC at all, much less in enteric coated delayed-release capsules.

Esopremazole is available OTC, but AFAICT only in delayed release form, and not in the same dosage used in Vimovo, which is immediate release esopremazole magnesium with a delayed release naproxen core; the esopremazole is to manage the side effects of the naproxen.

So, kitchen-table Vimovo from OTC supplies is not simple.

Naproxen sodium is merely a more stable version of naproxen. It’s effect and onset are identical. You just need to adjust the dosage. 220mg of Naproxen sodium is the same as 200mg of naproxen. As far as nexium, it’s not an extended release tablet, it just has an effect that lasts for 24 hours as it’s a non-reversible blocker of proton pumps in the stomach and it takes about a day for the body to make more of them.

Point is, aleve and nexium taken in an equal dose is almost identical to vimovo.

> Naproxen sodium is merely a more stable version of naproxen

Every source I can find that discussed the rationale for the development of the sodium salt says it was for more rapid uptake, not stability.

But the fact that Vimovo is an extended release naproxen tablet core and normal Aleve is not is a bigger deal than he naproxen/naproxen sodium distinction.

> As far as nexium, it’s not an extended release tablet

OTC Nexium 24 Hr is a delayed release esopremazole magnesium tablet according to the PDR and every other source. There are other Nexium-branded products (prescription) which are not delayed-release.

> Point is, aleve and nexium taken in an equal dose is almost identical to vimovo.

That might be true of prescription enteric-coated naproxen and immediate release esopremazole; it's not of OTC versions of Aleve and Nexium.

I also have AS and started with NSAIDs, and would advise you be very careful with your stomach. I was taking indomethacin that made the stiffness slightly manageable but acid reflux symptoms became a serious issue. After switching to Humira I have no more active pain or stiffness, with only some minor uveitis (in an eye that has many other issues). I wish someone would warned me earlier because my stomach has never been the same. Unable to even drink tea at the moment because of my reflux issues. Also to note, I have had zero issues with my immune system and I have been using it for about 5 years and through 3 eye surgeries.

I don't take drugs. I will take an immune regulating cure but not a immuno-suppressant like Humira. NSAIDs class of drugs are not good for long term treatment. They will physically destroy any semblance of health you may have.

I am glad to hear that exercise and diet works well for you, but there are some of us that aren't so lucky. I have been through four different rheumatologists, and plenty of non-drug related therapy attempts. I even consider myself lucky that Humira has been so helpful.

I can totally understand your choices though I think we can both agree that the current drug choices are very primitive due to their systemic efficacy. There are some interesting mouse studies that are investigating methods of targeted secretion of biologic drugs using CRISPR (modified viruses?) at the site of inflammation [1]. I'm hoping these progress to human trials soon.

[1] https://www.technologynetworks.com/genomics/news/a-crispr-ba...

> Currently I take NSAIDs, especially newer medicines like Vimovo https://www.vimovo.com/ helps a lot, but is not something you should take every day.

If you want to save some money then skip the Vimovo and take generics of the two active ingredients: Aleve (Naproxen) and Nexium (Omeprazole)

http://thehealthcareblog.com/blog/2015/11/04/dont-fall-for-t...

Only reason I can see to take Vimovo is if your doctor gives you a few samples at the office.

Aleve is naproxen sodium immediate release designed as a fast-acting analgesic, Vimovo uses slower-acting base naproxen in an enteric-coated delayed release tablet as the core around which the immediate release esopremazole magnesium is wrapped. The esopremazole magnesium —as well as he enteric-coating for the naproxen—is a technique to manage the potentially serious side effects of long-term use of naproxen.

If you can get your doctor to write you a prescription for separate enteric-coated delayed release naproxen and immediate release esomeprazole magnesium, that may be a suitable substitute.

Using the non-generic OTC medicines you (and the blog you cite) name, which would reverse which component has delayed released and use a faster-acting NSAID formulation is definitely not a suitable substitute. (Also, the non-physician writing the blog gets dosages wrong, suggesting 440mg of OTC Aleve—which he claims is naproxen, when it is in fact naproxen sodium—is a substitute for 500mg of base naproxen; if Aleve was naproxen you'd obviously need 500mg, not 440mg, but with naproxen sodium, the equivalent to 500mg of naproxen is 550mg of naproxen sodium, so in addition to magnifying the side effects the drug combo seeks to manage, his recommendation would seem to be underdosing for the intended therapeutic effect.)

And this is why you shouldn't take medical advice from someone whose qualifications for giving such advice seem to be that he is a health economist and former hospital accountant.

I write my comments assuming that anyone that gets legal or medical advice from anonymous commentators on the internet knows the usual "Ask your ________" prior to any of this and so skip the standard disclaimers.

That aside, great point and thanks for the great explanation!

The problem I have (more with the blogger) is that the stuff he overlooks (except the naproxen/naproxen sodium distinction, which I knew from looking it up previously in relation to a relatives prescription) is all stuff I found in less than a half hour of online research on the drugs in question; if you are a policy expert writing about substitutability of goods within the domain of your expertise, especially if in addition to underlying a polciy argument it's something that there is a risk people will act on in a personal health context, it's simply inexcusable to get all that wrong.

I exercise. Actually AS makes it so I exercise less than I would like to. I love exercising and was competitive at an international level as a teenager. I won't take TNFα's. Seems to be worse for my body than the disease. I'm more interested in positive sum treatments.