1. How do I know which biologic is right for me?
3. How often do I take the biologic? What should I do if I miss a dose?
4. Should I be worried about my risk of infection if I take a biologic?
5. I heard there’s an increased risk of cancer with biologics. Why should I still take this drug?
6. I’m dealing with depression related to ankylosing spondylitis, and I’ve heard biologics may help. How?
2. I’m afraid of needles. Does it hurt to get a biologic?
7. How much do biologics cost? Are they covered by insurance?
8. What are biosimilars? Are they the same as generics?
8. Will I continue taking other medications to treat ankylosing spondylitis while on biologics?
9. Will I have to take these medications forever?
8. Will I be able to afford this medication?
7. JAK inhibitors are still pretty new – are you sure they’re safe?
6. I read that JAK inhibitors increase the risk of blood clots. Should I be worried?
5. Can taking a JAK inhibitor cause cancer?
4. Why do I need to get certain vaccinations first?
3. Will taking a JAK inhibitor shut down my immune system?
2. If one JAK inhibitor doesn’t help me, does that mean none of them will?
1. Which JAK inhibitor is most likely to help me?
FAQs About Biologics, Answered
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There’s no easy way to find the right biologic from the get-go. This is due in part to how different our individual immune systems are. Just like we all look slightly different as humans, our immune systems are also slightly different, and the pathway for developing AS in one person would be different than in someone else. [So, we follow] a step-by-step approach, in which we try one biologic, and if it fails, then we move to the second-line biologic.
The technology behind the use of biologics has advanced. Different companies offer many ways of giving the injections, including the classic pre-filled syringe; and the more advanced pens, including SureClick auto-injectors in which the needle is barely visible. The needle itself may cause a very minor pinch sensation, but it doesn’t hurt per se.
The frequency of biologics varies depending on the specific biologic you’re taking. Some are offered on a weekly basis, while others are given every other week, monthly, every two months, or even every three months. If you miss a dose, it’s important that you let your rheumatologist know, but for the most part, you can take it as soon as you remember and then continue with your usual regimen from that date.
Yes and no. The idea of using a biologic is not to compromise the immune system, but to regulate and control inflammation and get the immune system to a point where it isn’t over-active or overly -inflamed. We certainly want our patients to continue to have functional immune systems to defend them against infections. On the other hand, over-activity is damaging to the body as well. Using biologics is all about striking a balance in the immune system, so it isn’t over-active, (causing bodily damage,) but also not over-suppressed, (leading to infections). Certainly, if there is a concern for active infection, then we’d need to interrupt the biologic until the infection resolves and then restart it. However, if the infection becomes recurrent on a specific biologic, then we would need to discontinue this specific biologic and consider an alternative.
Rheumatic conditions and cancers are [both signs of] an immune system not behaving well. As a matter of fact, people with autoimmune conditions are at a slightly higher risk for certain forms of cancer compared with people without autoimmune conditions. While the risk of cancer with using immune suppressants is slightly higher, this risk is not significant when compared with people not using the immune suppressants. The formal recommendations from the American College of Rheumatology is to consider treatment with immune suppressants to protect the body from the effects of inflammation and to closely follow up with your primary care provider for all age-appropriate cancer screening. There is no need to do any screenings beyond what is typically recommended at your primary care practice.
Depression and rheumatic conditions have a complex relationship, stemming from psychosocial stress from pain and skin changes. Also, the inflammatory molecules that promote autoimmune conditions like AS may take a toll on our brain health. We don’t have a clear understanding of the exact pathways involved in depression relating to AS, but overall, controlling inflammation with [biologics] and controlling these inflammatory molecules would help alleviate pain, control rashes, and improve symptoms in all three domains — (joints, skin, and overall inflammation —), which would hopefully help with depression as well. Regardless, if you’re experiencing depression and have an autoimmune condition, don’t wait for the biologic to take effect, but rather, make sure to follow up with your primary care provider or your mental health provider to help with treatments for depression. None of the depression treatments would interfere with the use of biologics.
Biologics are very costly, but many insurance plans would cover them after a trial of one or more conventional immune suppressants. The out-of-pocket cost should be minimal, and in many cases, there are support programs offered by the pharmaceutical company. If there are difficulties with affording medications, talk to your rheumatologist and their office about these support programs.
Depending on symptoms and the level of control of ankylosing spondylitis, and also depending on the degree of damage from inflammation, some people would only require one biologic, others may need to switch biologics, while yet others may benefit from a [more complex] approach to control pain with the help of a pain clinic specialist, after making sure that the pain from inflammation is well controlled
Possibly. While you can only take one biologic at a time, you may take other medications, such as NSAIDS, for pain and stiffness, but you usually don’t need to. If your ankylosing spondylitis is stable on a biologic, it’s not recommended that you stop taking the medication or taper your dose, according to guidelines from the American College of Rheumatology. Work with your doctor to find the right treatment plan for your needs.
9. Will I continue taking other medications to treat ankylosing spondylitis while on biologics?
