Biologic losing efficacy?
I'm concerned my latest biologic, Tremfya, is not working as well as it did at first. I've been on methotrexate, Humira, Cosentyx, Stelara, and now Tremfya over the years. The pattern has been on the Tremfya that the last week before the next dose would get pretty miserable pain-wise. It would take about a week to start feeling better again. It progressed to the last 2 1/2-3 weeks being painful to the next two weeks before pain relief after injection. This last dose was 3 weeks before I started getting pain relief. Is this a sign that this biologic is losing its efficacy, and I need to change meds? The rheumy has been talking about changing it for the last 2 visits (every 4 months), but I've been hesitant. I'm an athletic trainer for a university and was trying to get through the school year before I changed meds if that is, in fact, the direction I need to go. I was hoping it was just the 60-70 hour work weeks that were affecting it. Any thoughts?
Hi
you could be right on either part of what you are thinking. It could be the Tremfya is starting to fail but it also could be the amount of work time you are putting in especially being an athletic trainer. The only way you would know is waiting on that school break when you won't have that amount of hours. If you are not wanting to switch Tremfya right now you can ask your doctor about adding another therapy to it and try it that way. Sometimes doctors will put methotrexate or even another biologic with a biologic. That is a conversation you need to have with your doctor. Please keep us posted if you don't mind. Vickie W., Team Member 
Vickie is right on point. Also, I've found that something as seemingly innocuous as a flu shot, or less innocuous, a COVID booster, can cause me to flare, and even "pause" the effects of my biologic for a short period of time. But, there also comes a time when it's best to move on from a biologic that just isn't cutting it anymore. I've followed nearly the same cycle and regimen as you, and I've begun to fear that my biologic (Skyrizi) is beginning to wane in efficacy, but I'm just not sure. Some of the side effects mimic some of the effects of PsA, so .......... But, once you have a break from such long hours, and can take better care of yourself, you may see a bounce back to where you were before. My personal experience is thus; as a long distance runner, the harder I trained, the more stress I put on my body, the more my biologic would wane in efficacy. But, after a really bad sacral fracture last spring, I was forced to rehabilitate for several months before beginning running again. But, this time, I am taking things differently; I am running 5k's rather than 1/2 marathons, and therefore have significantly reduced my training load. This has led to greater consistency in my condition. So, give yourself a break, and when you return to work, cut back on your workload. thank you for responding. I’m so sorry you had that fracture - super painful! As an AT I’m really glad you did your PT and modified your workouts! Lol, I’m really good at the “do as I say, not as I do”! 🙄😂
My AD has already made changes to my workload starting this fall. He doesn’t want me to work more than 30 hrs a week, but that’s not really realistic for ATs. I’m going to really try to behave and not work so much and get better at the saying no! This has been a super stressful year (that was my golf team that had the fatal wreck last year so between the emotional toll and all of the extra work that resulted from it, I shouldn’t be surprised with how the biologic has been working) and I’m hoping next year will “calm down” at least a little bit! Thank you again and I hope your modification continues to work for you!
