Biologic prescriptions
I'm wondering if anyone knows why blood tests for specific inflammation markers, i.e IL23, TNF, etc aren't done BEFORE prescriptions are made for the different biologics such as Humira, Skyrizi, etc. As near as I can determine, they all target different types of inflammatory substances. So many of us are tried on one after another to find the right one. It makes sense that a TNF blocker would not work if a patient doesn't have that as their primary cause of their inflammation. Does anyone reading this have more knowledge on tests for specific cytokines? I have seen that the tests exist and wonder why they aren't done prior to prescribing.
A lot of this depends upon the particulars of each and every patient. Regardless of whether or not a given biologic is given to target a specific cytokine that is believed to be driving the disease in a given patient, there is no guarantee it will work. From my reading, and discussions with doctors, it looks to be the IL-17/IL-23 axis that is the primary driver of disease, and everything else basically happens downstream. So if you can address PsA at this axis, then theoretically, you can better affect a positive disease outcome for the patient. That being said, there is plenty of evidence to support that concomitant use of traditional DMARDs with bDMARDs may prove more efficacious in limiting immunogenicity in biologic use. Furthermore, it's still not well understood exactly what role each of these cytokines plays throughout the duration of the disease over time; i.e. which cytokine drives skin involvement, which one drives enthesitis, and so forth. And then there are the JAK inhibitors, which is a totally different class of drugs all together. So you could spend a lot of time getting tested for various cytokines, and it may well prove fruitless in your search for an ideal treatment model. So rheumatologists basically prescribe based upon their experience and knowledge of what may work based upon where they believe a patient is in their stage of disease development.
Thanks for your reply. Yes, I have read in National Institute of Health about the IL17/23 involvement in joint, gut, and brain involvement. I can't take traditional DMARDS due to allergy to various ingredients. After taking 4 TNF blockers which either had no affect or caused my psoriasis to get significantly worse, my dr now has me on Skyrizi. It cleared my skin almost completely in less than 2 weeks, joints however...not so sure. That could be due to OA though, not sure. In talking to other PSAers I have heard a lot about being tried on multiple bios with similar experiences to mine. That is why I was wondering about testing for the cytokines a particular biologic is formulated to treat. It just seems like we're all guinea pigs for these new technologies. Thanks, again, for taking time to reply. Cheers!
Welcome to the online community of guinea pigs.
😂
New guinea pig here! Been through Enbrel and Humira (with methotrexate of course) and my new Rheumatologist is recommending a transition to Cosentyx. I already have moderate degeneration of an MTP joint and I am focused on preserving my joints. He is telling me that by the end of the year, they are releasing IV version so he can give monthly IV therapy at a higher doses. He also likes that it does not have the black box warnings that Humira does. After reading some helpful posts and doing some research, I am going to try it. Hold good thoughts!
