Cessation of Biologic Therapies for Psoriatic Arthritis: Reasons and Consequences
Psoriatic arthritis (PsA) is an immune-mediated disease that leads to joint pain, swelling, and stiffness. Treatment for PsA often involves biologic disease-modifying antirheumatic drugs (DMARDs), also known as "biologics."
Stopping biologic therapy for PsA can lead to a variety of consequences. According to recent studies, discontinuing biologics may cause a return or worsening of psoriatic arthritis symptoms, including joint inflammation and skin lesions, as the systemic anti-inflammatory effect of biologics is removed. This could potentially lead to a disease flare or progression.
Patients may also lose the clinical benefits achieved, which can include increases in psoriasis severity and joint damage risk. In such cases, after stopping, patients often require switching to another biologic or resuming treatment to regain control, given many discontinue initial therapy due to ineffectiveness or side effects.
Given these potential risks, it is generally recommended to consult a rheumatologist before discontinuing biologic therapy. Decisions about stopping or modifying biologic treatment in PsA should be made in consultation with a rheumatologist, who can evaluate both joint and skin disease activity and balance risks and benefits.
A rheumatologist's assessment is important in several scenarios. For instance, if PsA is active or not in remission, ensuring disease is controlled enough to consider discontinuation safely is crucial. Similarly, if a biologic is not effective or causes adverse events, a rheumatologist can guide switching therapies or dose adjustments.
Moreover, since treatment must consider both conditions, rheumatologists and dermatologists should collaborate before changing biologic therapy. In some cases, a rheumatologist may suggest adding on another therapy rather than stopping the initial therapy.
It's also worth noting that 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. The American College of Rheumatology recommends continuing anti-tumor necrosis factor medications throughout pregnancy and lactation.
Immunogenicity, the development of an immune response in the form of antibodies against a medication, is a potential issue when stopping treatment for biologics. This risk may be more common with dose interruptions than with continuous use.
In summary, stopping biologic therapy for PsA carries risks of disease flare and loss of control; therefore, consulting a rheumatologist before making such decisions is critical to ensure appropriate monitoring and management changes are made to maintain disease remission and patient safety. People who wish to stop biologic treatment due to side effects may benefit instead from a dosage reduction.
People should not make any changes to their dosage without first consulting their healthcare team. Healthcare professionals may recommend temporarily interrupting biologic treatment before surgeries or for people with active symptoms of COVID-19.
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.
In conclusion, managing PsA effectively requires careful consideration and collaboration between patients, rheumatologists, and dermatologists. By working together, patients can make informed decisions about their treatment and maintain control over their disease.
- Psoriatic arthritis (PsA) is characterized by joint pain, swelling, and stiffness, and its treatment often involves biologic disease-modifying antirheumatic drugs (DMARDs).
- Discontinuing biologics for PsA may cause a return or worsening of symptoms, potentially leading to disease flare or progression, and patients might need to switch to another biologic or resume treatment.
- A rheumatologist's assessment is vital in deciding whether to discontinue biologic therapy, considering both joint and skin disease activity, and balancing risks and benefits.
- Rheumatologists and dermatologists should collaborate when changing biologic therapy, as treatment must address both arthritis and psoriasis conditions.
- Pregnant women can usually continue biologic therapy during the first and second trimesters but should discontinue it during the third trimester, according to some experts.
- Immunogenicity, the development of an immune response to a medication, is a potential concern when stopping biologic treatment, as it may increase with dose interruptions.
- Healthcare professionals may recommend temporarily interrupting biologic treatment before surgeries or for people with active symptoms of COVID-19.
- If cost is an issue for stopping biologic therapy, patients can work with their rheumatologist and pharmacist to research options for reducing the price, such as discounts through Optum Perks or manufacturer programs.
- Effectively managing PsA demands careful collaboration between patients, rheumatologists, and dermatologists, helping patients make informed decisions about therapies and treatments for their chronic diseases and health-and-wellness.
