Choosing a Biologic to Fit Your Lifestyle

Between my son and myself, we’ve tried nearly every biologic approved for psoriatic arthritis. Often they would work for about eight months before the effectiveness would wear off. In the early years, we had few options, but with more research and newer biologics coming on the market, we now have real choices to treat our psoriasis and psoriatic arthritis. And now, we can start to think about which one will fit our lifestyles. The easier it is for us to take the medication, the more likely we are to comply, which often leads to better results.

Questions we now consider: Should we take the medications by infusions or injections? Do we want to try a biologic given every week or just once a month? And, perhaps most importantly to a child, which one will hurt the least? (Ok, I admit it. As an adult, I didn’t want pain from medication either.)

What biologics are available for us?

Here is a recap of some biologics – listed in alphabetical order – available for psoriatic arthritis. Since each patient is different, I won’t go into detail about what worked the best to get our diseases under control. Rather, this is to provide information that may help you and your doctor choose a biologic that works best for your lifestyle, making it easier for you to comply with your treatment plan. Of course, what insurance will cover and out-of-pocket costs will also likely play into your decision.

Cimzia

• Dosing frequency: Usually given every two weeks
• Delivery method: Injection (pre-filled syringe) under the skin
• How it works: Targets a protein called tumor necrosis alpha-factor (TNF-alpha) that causes psoriatic arthritis.
• Likes: I can give myself the injections at home, and I only have to do it twice a month.
• Dislikes: The medication burns A LOT as it is being administered. However, because it comes as a pre-filled syringe, I can control how fast or slow I want to inject the medication, which means I can also control how much it hurts for how long.

Cosentyx

• Dosing frequency: Usually given as five weekly doses followed by one dose a month
• Delivery method: Injection (auto-injector) under the skin
• How it works: Targets a protein called IL-17A
• Likes/dislikes: Since neither my son nor I have taken Cosentyx, I can’t personally comment with likes or dislikes.

Enbrel

• Dosing frequency: Usually given once or twice a week
• Delivery method: Injection (auto-injector) under the skin
• How it works: Targets TNF-alpha
• Likes: When my son first started on Enbrel, we had to mix the medication ourselves and give it to him in a syringe. He took it twice a week, so the process was daunting. Fast forward some years, and now it comes in auto-injector that I find easy to use. Also, I only need to administer it once a week.
• Dislikes: Both my son and I tended to get sick more often when we are on Enbrel. This isn’t true for everyone, so I wouldn’t use this as a reason to avoid Enbrel.

Humira

• Dosing frequency: Usually given every two weeks
• Delivery method: Injection (auto-injector) under the skin
• How it works: Targets TNF-alpha
• Likes: It’s given only twice a month, and I don’t tend to get too sick from colds and viruses.
• Dislikes: The auto-injector is a bit hard to use when my hands are in a flare, and I find the medication burns when it enters my body, though not as bad as Cimzia.

Orencia

• Dosing frequencies/delivery methods:Infusion: Usually administered in a doctor’s office as a 30-minute infusion given once per month, after two starter doses two weeks apart. Pre-filled syringe or auto-injector: Usually given once per week.
• How it works: Gets in the way of T-cell activation, reducing the amount of signals that can be sent that lead to inflammation.
• Likes: My son was prescribed Orencia when it first came on the market. He was in a major flare and had already tried all other biologics available at that time. He took the pre-filled syringe at that time. I like that there are different options now to take the medication, which allow patients to choose the one delivery method that is right for them. If given by infusion, patients can schedule a check-up at the doctor’s office at the same time to avoid extra appointments. It’s nice that this infusion usually lasts only 30 minutes, so patients don’t need to take a whole day off of work. And if giving the injection to yourself works better for you, it’s easy to remember which day to administer the medication (example: every Friday).
• Dislikes: Since my son was only on this medication for a two months, I can’t personally comment with any dislikes.

Remicade

• Dosing frequency: Usually given as three infusions during the first six weeks, then given once every eight weeks
• Delivery method: Infusion (IV) given in a doctor’s office, infusion center or hospital
• How it works: Targets TNF-alpha
• Likes: My son was the only one who took Remicade. It was nice that he could sleep during the infusion and medical staff watched him carefully. Since it was given every other month, he could see his doctor for a check-up at the same time as his infusion.
• Dislikes: Rare anaphylaxis reaction aside, it did take at least five hours for each infusion, so it really was time-consuming. I had to take a whole day off of work.

Simponi

• Dosing frequency: Usually given once a month
• Delivery method: Injection (auto-injector) under the skin
• How it works: Targets TNF-alpha
• Likes/dislikes: Since neither my son nor I have taken Simponi, I can’t personally comment with likes or dislikes.

Stelara

• Dosing frequency: Usually given every 12 weeks, after two starter doses four weeks apart
• Delivery method: Injection (pre-filled syringe) under the skin
• How it works: Targets two proteins: IL-12 and IL-13
• Likes: We only have to think about our medication every three months. Yes, every three months!
• Dislikes:Insurance dictates that our doctor must administer the medication. Also, since biologics suppress the immune system, if we get a cold or virus, we can’t easily hold the medication until we get better. Stelara most likely is already in our system for a longer period of time because we receive the medication every 12 weeks.

Taltz

• Dosing frequency: Recommended dose is two injections to start, followed by one injection once a month. (According to the prescribing instructions, for patients who also have moderate-to-severe plaque psoriasis, recommended dosing regimen is two injections to start, followed by one injection every two weeks for three months, followed by one injection once a month.)
• Delivery methods: Pre-filled syringe or auto-injector
  How it works: Targets IL-17A proteins that are involved in the inflammatory process.
• Likes/dislikes: Since neither my son nor I have taken Taltz, I can’t personally comment with likes or dislikes.

Xeljanz

• Dosing frequency: Recommended dose is 5 mg taken twice daily, used in combination with nonbiologic DMARDs, such as methotrexate; or 11 mg taken once daily, used in combination with nonbiologic DMARDs, such as methotrexate.
• Delivery methods: Tablets, for oral use
• How it works: JAK inhibitor that interferes with the immune processes in psoriatic arthritis.
• Likes/dislikes: Since neither my son nor I have taken Xeljanz, I can’t personally comment with likes or dislikes.

These are some additional things to consider when choosing a biologic. Be sure to have an open conversation with your doctor so that you both can work together to decide on a treatment option that will best suit your lifestyle and disease symptoms.