A person may find that symptoms of psoriatic arthritis (PsA) return when they stop biologic treatment. Still, stopping may be necessary in some instances, such as before and during pregnancy, prior to surgery, and during active viral infection.
PsA is an immune-mediated disease that occurs when the immune system mistakenly attacks the body’s own tissues. This attack leads to tissue damage and inflammation that can cause pain, swelling, and stiffness in the joints.
The goal of PsA treatment is to reduce the underlying inflammation.
Doctors treat many people with PsA using a class of medications known as biologic disease-modifying antirheumatic drugs (DMARDs), which they commonly refer to as “biologics.”
Biologic DMARDs are highly specific medications that target the key causes of inflammation in PsA to reduce symptoms. However, in some cases, a person receiving biologic therapy may want to stop their treatment.
This article looks at why some individuals may wish to stop biologic treatment for PsA. It also discusses the potential effects of treatment interruptions and considers alternative steps to avoid stopping therapy.
People may wish to discontinue their biologic treatment for PsA for various reasons. Some possible reasons for wanting to stop treatment include:
- the resolution of symptoms
- dissatisfaction with the treatment results
- intolerable side effects
- pregnancy or anticipated pregnancy
- upcoming surgery
- cost-related concerns
Although it may sometimes be necessary to discontinue treatment, healthcare professionals generally recommend that people with PsA taking biologic therapy do not stop it without first consulting their rheumatologist to understand the potential risks and benefits.
What to do if treatment for PsA stops working.
The effects of stopping treatment with a biologic in PsA will depend on the specific type of medication.
Researchers reported the findings of a first-of-its-kind
The researchers then randomly assigned these 158 individuals to treatment withdrawal or continuation of treatment with ixekizumab. Of those who discontinued biologic therapy, 85% experienced symptom relapse within 2 years, compared with 38% in the group who continued treatment. Relapse also occurred more quickly following treatment withdrawal, occurring within 22 weeks, on average.
Although this was the first study that specifically described the effects of biologic treatment discontinuation, the
Restarting treatment may help some people regain disease management, but others will find that treatment is not as effective as it was.
Another potential issue of stopping treatment for biologics is that immunogenicity can occur. Immunogenicity is the development of an immune response in the form of antibodies against a medication.
Although studies on the immunogenicity of biologics in PsA are limited, research involving people with inflammatory bowel disease suggests that the development of immune responses against biologics may be
However, overall, the research suggests that immunogenicity to biologics in psoriatic disease is rare. Therefore, this is unlikely to be a concern regardless of whether a person stops treatment.
What to know about biologics for PsA.
Experts generally recommend that people should not stop biologic treatment unless necessary.
As biologics treat PsA by suppressing the immune system, it is possible that their use during surgery may leave people more vulnerable to infections.
Therefore, healthcare professionals may recommend temporarily interrupting treatment for as little as one dose before any planned surgeries. They generally make such recommendations on an individual basis, taking into account the potential risk of infection and recent PsA activity.
The immunosuppressive effects of biologics also mean that the medical community
Pregnancy
In some cases, people may also need to stop biologic treatment while pregnant or if they plan to become pregnant. However, this will depend on the type of biologic they are taking.
Although research on the effects of biologic therapy in pregnancy is limited,
However, the American College of Rheumatology notes that based on current research, most rheumatologists will recommend continuing anti-tumor necrosis factor medications throughout pregnancy and lactation.
In some cases, the symptoms of psoriatic disease may worsen during pregnancy. If necessary, some experts suggest that people can continue biologic therapy during the first and second trimesters of pregnancy but should discontinue it during the third trimester. This allows the safe delivery of live vaccines during the first 6 months of the baby’s life.
Whether a person continues biologic treatment for PsA during pregnancy should involve a discussion between the individual and all members of their healthcare team.
If a biologic does not help manage PsA symptoms, a rheumatologist may suggest adding on another therapy rather than stopping the initial therapy, which may cause the symptoms to worsen.
Combination therapy with another type of systemic therapy may help a person
People who wish to stop biologic treatment due to the side effects may benefit instead from a dosage reduction, which usually reduces the side effects without completely removing the benefits of the therapy.
Although the evidence supporting dosage reductions in PsA biologic therapy is limited, doctors often get good results from using this practice in other autoimmune conditions. People should not make any changes to their dosage without first consulting their healthcare team.
If cost is a factor in stopping biologic therapy, a person can work with their rheumatologist and pharmacist to research options for reducing the price. They may also be able to find discounts through services such as Optum Perks or manufacturer programs.
Below are some common questions about biologics.
Can you take a break from biologics?
Yes, people may wish to take a break for several reasons. However, they should discuss this with a doctor first.
Usually, it is better to take biologics continuously to stay in remission.
How long does it take for biologics to leave your system?
This varies from person to person. As a point of reference, in a healthy adult, it may take
Do you have to stay on biologics for life?
There is no specific length of time that a person needs to take biologics. Usually, people may continue taking the medication as long as it is effective.
This might include lifelong treatment.
Can you stop and restart a biologic?
Yes, but for some people, stopping and restarting may mean the biologic does not work as well.
Stopping biologic therapy for PsA may be necessary in some instances, such as before and during pregnancy, prior to surgery, and during active viral infection. However, doctors do not generally recommend discontinuing treatment with a biologic, as doing so can leave people vulnerable to relapse.
Before stopping treatment with a biologic medication for PsA, a person should consult a rheumatologist, who can suggest alternative options to help improve treatment management or reduce the side effects of treatment.
If cost is a significant barrier to treatment, healthcare professionals can also help people navigate the reimbursement resources available from pharmaceutical companies.