Biologics have advanced the treatment for psoriatic arthritis (PsA) and vastly improved outcomes for many people. However, stopping them can cause your symptoms to come back.
While biologics are an effective treatment method for PsA, like all medications, they come with potential side effects. For instance, they can increase the risk of adverse events during surgery, pregnancy, and other life events.
Stopping a biologic can result in the return of PsA symptoms. A number of considerations can help you decide whether it’s right to pause or cease your biologic medication.
Treatment for PsA depends on the severity of your symptoms. First-line medications for mild PsA include over-the-counter (OTC) medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Your doctor may suggest prescription-strength NSAIDs, which have higher doses and last longer.
If first-line treatment is not effective, a doctor may recommend one of a class of disease-modifying antirheumatic drugs (DMARDs).
Biologics are a particular kind of DMARD that target specific parts of the immune system to reduce inflammation. Conventional DMARDs, like methotrexate, work on the immune system more generally.
If conventional options have not helped you reach your treatment goals, you might consider a biologic. You may also look into a biologic if you have moderate to severe PsA.
There are two main types of biologics used to treat PsA, each with a unique target and with its own benefits and risks:
- Tumor necrosis factor-a (TNF) inhibitors: Adalimumab (Humira), certolizumab pegol (Cimzia), etanercept (Enbrel), golimumab (Simponi), and infliximab (Remicade)
- Interleukin inhibitors: Ixekizumab (Taltz), secukinumab (Cosentyx), guselkumab (Tremfya), risankisumab-rzaa (Skyrizi), and ustekinumab (Stelara)
Some doctors may recommend a treatment plan that includes a biologic, such as methotrexate, along with a conventional DMARD.
Biologics are generally safe and effective treatments. However, they affect your immune system, leaving your body vulnerable to infection and have other side effects. You may decide to stop your biologic treatment when the risks outweigh the benefits.
Some factors that may indicate it’s time to take a break include:
Pregnancy or breastfeeding
There’s limited research on biologics while nursing, but it’s thought that any adverse effects are minimal. According to one
A TNF inhibitor called certolizumab (Cimzia) is safe to use during pregnancy because it doesn’t cross the placenta. However, people commonly stop taking immune-modulating medications during conception and pregnancy.
It’s always a good idea to speak with your doctor before starting or stopping your medication.
Diagnosis of a new medical condition
Treatment for some conditions, such as cancer or diabetes, can increase your risk of infection. If you receive a new diagnosis, your doctor might suggest you taper, change, or stop using a biologic for PsA.
Plans to undergo surgery
All surgeries come with the risk of infection. If you’re about to undergo a procedure, your doctor may discuss a plan to pause your biologic prior to the event and during your recovery.
In some cases, they may recommend you continue taking your medication. However, people often opt to pause biologics until after the immediate post-operation recovery.
Receiving vaccinations
Some vaccines contain a live virus, which can present risks for people taking biologic medications. Examples include the smallpox, yellow fever, measles, mumps, and rubella vaccines.
It’s a good idea to talk with your doctor about coordinating your vaccination schedule with your biologic treatment.
Also, since biologics increase the risk for infection, it’s recommended that you get vaccinated against common infections, such as influenza, pneumococcus pneumonia, shingles, COVID-19, and hepatitis B before starting them.
Moving to certain regions
There’s a higher risk of a serious condition called histoplasmosis in certain geographic regions such as the Ohio and Mississippi River Valley. If you’re going to relocate to any of these areas, you may want to discuss whether to adjust your biologic treatment.
Low disease activity
Most doctors recommend continuing with a biologic treatment even after you have achieved minimal or low disease activity. If treatment stops, people often experience a later flare or relapse.
One of the benefits of continuing treatment is preventing long-term irreversible joint and tendon damage.
Stopping a biologic can cause a PsA relapse or flare up.
If you hadn’t reached prolonged remission before stopping your medication, your symptoms may come back. There’s also a rebound phenomenon — when the immune system is repressed, taking away the medication can cause a significant reaction, causing even more severe symptoms to crop up.
Because of this, it’s a good idea to taper off immunosuppressants. This helps your immune system gradually adjust to the changes.
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If you pause your biologic, you may no longer experience the drug’s side effects. But over time, stopping and starting a biologic can cause the medication to not work as well.
You may also have a lower risk of infection, so in the case of some life events, like pregnancy or surgery, it may be a reasonable option.
Your doctor can help you determine what options are available for your particular situation. If your biologic has stopped working, you may be able to switch to a different biologic instead of stopping treatment completely.
If you’re considering stopping your biologic treatment for PsA, you may want to discuss some important points with your doctor. Questions you might want to ask include:
- Can I switch my biologic treatment to a different one to increase efficacy or reduce side effects?
- Can I take my biologic if I get pregnant?
- How long before surgery should I stop my biologic?
- When can I receive vaccinations?
- Can I return to conventional treatments like NSAIDs and non-biologic DMARDs?
- Is it possible to reduce or taper down my dose if I achieve remission?
It’s usually a good idea to speak with your doctor whenever you have questions or concerns about your medications, so you can decide on the treatment plan that’s best for you.
Here are some questions people often ask about biologic treatments for psoriatic arthritis:
Can psoriatic arthritis go into remission without medication?
Most people achieve remission through one or a combination of medications. Even those with mild PsA usually use over-the-counter drugs such as NSAIDs to control inflammation.
How long do you stay on biologics for psoriasis?
People generally stay on a biologic for as long as it’s effective. It’s likely safe to use a biologic for an extended period of time.
Can I go back on biologics after stopping them?
You can restart a biologic after stopping. Biologics work best if a person takes them continuously, as stopping and restarting the medication can lead to reduced effectiveness.
Biologics are generally safe and effective drugs for PsA. Stopping a biologic can reduce the medication’s effectiveness and cause the return of PsA flares.
You and your doctor may nonetheless decide to stop a biologic when the risks outweigh the benefits.