6 Signs It’s Time to Switch Psoriatic Arthritis Treatments

1. You’re experiencing side effects

DMARDs, like methotrexate, are known to cause side effects such as:

• mouth sores
• nausea
• upset stomach
• vomiting
• abnormal liver function
• diarrhea
• fatigue
• reduced number of white blood cells

Biologics work in a more selective way than DMARDs. They often have fewer side effects than the less-targeted treatments. Biologics can still cause side effects, but they tend to be less common.

Common side effects of biologics include:

• redness and rash at the injection site
• increased risk of serious infections
• lupus-like symptoms, such as muscle and joint pain, fever, and hair loss

Rare side effects of biologics include serious neurologic disorders such as multiple sclerosis, seizures, and inflammation of the nerves of the eyes.

If you’re taking a DMARD or immunosuppressant and your side effects are too severe, it may be time to ask your doctor about switching to a biologic.

Your doctor might also consider the possibility of combining your current DMARD therapy with a biologic. Combining treatments can make them more effective while lowering the dose. This, in turn, can help decrease side effects.

If you have a compromised immune system or active infection, avoid taking biologics for your PsA.

2. Your PsA is not responding to your current treatment regimen

There’s no one-size-fits-all treatment for PsA. You might find that one biologic seems to work for a little while, but suddenly your symptoms get worse again. Switching biologic therapies is recommended for people who experience treatment failure.

Your doctor will consider many factors before deciding which therapy to switch you to. These factors include your treatment history, disease characteristics, other conditions you may have, and other risk factors.

Your doctor may also consider your health insurance coverage and out-of-pocket costs.

There are nearly a dozen biologics now approved to treat PsA. Many more are in the pipeline.

Approved biologics include:

• tumor necrosis factor (TNF)-alpha inhibitors, such as:
  • certolizumab pegol (Cimzia)
  • etanercept (Enbrel)
  • adalimumab (Humira)
  • infliximab (Remicade)
  • golimumab (Simponi)
• interleukin (IL)-12/23 inhibitors, such as ustekinumab (Stelara)
• interleukin (IL)-17 inhibitors, such as:
  • secukinumab (Cosentyx)
  • ixekizumab (Taltz)
  • brodalumab (Siliq)
• T-cell inhibitors, such as abatacept (Orencia)
• Janus kinase (JAK) inhibitors, such as tofacitinib (Xeljanz)

If one treatment does not work, your doctor will carefully consider which biologic to try next. This is based on current treatment guidelines and recommendations.

Research shows that adalimumab and etanercept may not work as well if you’ve already tried a TNF inhibitor. On the other hand, ustekinumab and secukinumab show better efficacy in cases that do not respond to a TNF inhibitor.

This is also a good time for your doctor to consider combining treatments. According to the Arthritis Foundation, infliximab, etanercept, and adalimumab are more effective when taken with methotrexate.

Keep in mind that it may take up to 3 months or more for a biologic to take full effect.

3. You have new symptoms

New symptoms or an increase in flare-ups could be a sign your current treatment regimen isn’t working.

Talk with your doctor about switching treatments if you start having any of the below symptoms or your current symptoms get worse:

• back pain and stiffness
• pain in a different joint
• damaged nails
• signs of bowel inflammation, like diarrhea and bloody stool
• swollen fingers and toes
• eye pain, redness, and blurred vision
• severe fatigue

Also speak with your doctor about switching treatments if X-ray results start to show joint damage or an ultrasound of joints shows active inflammation.

4. Costs are getting too high

As you may already know, biologics can be expensive. Your insurance may not cover all the costs, leaving you with a hefty part of the bill.

If you have insurance, speak with your insurance company about how much they will cover for each biologic for PsA. It may turn out that certain brands have lower copays or out-of-pocket costs than other treatments.

There’s also the possibility of switching to an approved biosimilar, such as:

• etanercept-szzs (Erelzi)
• adalimumab-atto (Amjevita)
• infliximab-dyyb (Inflectra)

Biosimilars are a type of biologic therapy similar to biologics that are already approved by the Food and Drug Administration (FDA).

Biosimilars need to show no clinically meaningful differences from the existing biologic for FDA approval. They’re usually less expensive.

5. You’d prefer to take fewer doses

It’s important to consider your preferences and schedule when choosing a treatment.

Some PsA treatments need to be taken daily. Some biologics are taken once per week, while others are dosed every 2 weeks or once per month.

Ustekinumab (Stelara) is injected only once every 12 weeks after the first two initial doses.

You may prefer treatments that have less frequent dosing regimens if injections or infusions aren’t working with your schedule.

6. You’re pregnant or thinking about becoming pregnant

The effects of biologics on a developing fetus aren’t fully understood. It’s possible that these medications could result in pregnancy complications.

If you’re pregnant or thinking about becoming pregnant, proceed with caution and stop or switch treatment. Reach out to your doctor for advice.

Certolizumab pegol (Cimzia) isn’t actively transported across the placenta. This makes it a safer option during pregnancy. It’s now the recommended biologic during pregnancy or if you’re trying to become pregnant.

Takeaway

PsA is a long-term condition. Your quality of life depends on how you manage the disease with lifestyle strategies and medications.

While flare-ups may be temporary, it’s still important to treat your condition as a whole. If you’re unhappy with your current treatment, talk with your doctor about modifying your treatment plan.