Medications and Biologics

[Kat]

I know a lot of people here prefer one over the other. I'm currently on Acitretin which other than topicals and UVB is the only treatments I've tried. I haven't gotten the results (so far) I had hoped for, it doesn't seem to be helping all that much with the psoriasis on my scalp. So, I'm preparing for my next dermatologist visit, which is a month away. I'm trying to get better educated on treatments and will be the first to say that I do NOT have a scientific mind so a lot of technical talk on meds flies right over my head. So here goes:

Medications for psoriasis.... if I understand correctly they are fighting the symptoms of psoriasis. They can help slow down cell growth but are more designed to help with the redness and flaking and hopefully decreasing it. Once you get it under control, the meds can help keep you from flaring, perhaps because of lessening the symptoms and thereby helping a body keep it under control? The side effects vary by person and can be mild or harsh. I only know about Acitretin, but since it can "damage" a baby if the woman is pregnant, one can't help but wonder what exactly they are putting in their system.

Biologics.... Seem to work the "best" and I can only base this by reading this forum and also since my dermatologist said it's an option but in his case (or perhaps insurance) it's the last treatment he goes to. Since he said he tries to start at the lowest treatment and work up to see what works, I take it that biologics (in his opinion) is the highest treatment, but the one with the highest risks. My guess (again, I guess a lot) is that would be because it can affect the immune system. I know (from here) that there are side effects (mostly flushing) but no one (here) seems overly worried about that. However, if I understand correctly, the biologics target the T-cells (not that I know what those are) and directly fight the disease where it is started.

I'm not trying to say one is better than the other, first what works best for each individual is going to be different. What I'm trying to do is understand these medications. I want to understand enough to ask the dermatologist questions and to be part of what (IF it becomes necessary) the next step would be for me. I'm not trying to have this be a debate over one being "better" than the other, but I would like to know for those who prefer one over the other, why it is they think it is the better choice for them. Also, if so inclined, why you wouldn't use one or the other.

[Caroline]

I see Fred's already replying. Think that will clear up and give information.
Maybe I will add to that later.

[jiml]

Kat I'm afraid I'm not clever enough to give you any answers, you are an astute person and I'm sure you will decide for yourself what is likely to be "best" I think most of us can only advise on what we have tried and I think like you we give a biased view.
What you are doing at the moment works for many, but you have a feeling it's not doing it for you, and are rightly thinking of the next step......
I think the best person to guide you will be your dermatologist in conjunction with your insurer, as they seem to have the final say.
I'm sure that they have protocols they have to follow and you will,have to fail those before you can move on.
I was very lucky with my hospital it only took around forty years to get me on a medication that actually controls my psoriasis. I went through all treatments and had varying degrees of success, I won't say I've been covered all my life in psoriasis but it has always lurked and always came back in the winter
As I say it's no good me recommending my treatment as it's not available to you in America if it was I would recommend it highly as it is far less toxic than most treatments.
I'm sure others will be able to advise and point you in the right direction, but as I said at the start you are doing the right thing by researching now. Ready to go armed with some ideas.

[Fred]

As you know I'm a big fan of the bio treatments, and that would be the way to go in my opinion. The main reason I say that is because they work fast, will give you your life back, are simple to take, and there are around 5 types with more in the pipeline.

Without boring you to much the basics are "Biologic drugs are made from living human or animal proteins. They are designed to treat psoriasis and psoriatic arthritis by targeting overactive cells in the body. Some biologics target a type of immune cell called T cells while others target the chemical messengers released by activated T cells." T cells in a person with psoriasis are over active, have a read of this thread for a simple explanation: T Cells the soldiers in your body

Yes you will see negative points about them as you will with any treatment, but mostly that comes down to your immune system will be a little weaker so you could be more susceptible to get infections or viruses. The flushes you mention are more associated with Fumaderm and not with the Bio's, the biggest risk is probably tuberculosis (TB) and you will & should be checked before stating them.

The worst I've experienced and I've tried them all apart from Simponi was a reaction which I had from Remicade and Humira, my body just didn't like them and I turned into a lobster. That was soon fixed with nice soothing baths in hospital and switching to Enbrel. I've had a few flu or cold like symptoms, mostly after starting but now my body is settled down to my current one Stelara I have no problems.

I agree you don't want it to be a debate and rightly so, as like you said what works for some may not work for others. But as for why I think the Bio's are a better choice for me and why I wouldn't use the others.

#1 The Bio's have given me my life back, and have been the best treatment I have ever had.
#2 They are easy to take with a simple injection under the skin (apart from Remicade which is given by infusion) this is a bonus for me as I hate taking tablets.
#3 The only tablet treatment I have tried was Methotrexate and I think you have read enough about my thoughts on that.
#4 I wouldn't try any of the other tablet form as I don't like the sound of the side effects, and I hate taking tablets.

I recently was considering Fumaderm as I've seen good result's and low side effects from members on here, but decided I don't like tablets and Stelara is still working very well so why change. plus it could always remain an option if needed later on.

At the end of the day you have to do what you feel is best for your body, and most importantly remain in charge of what you are happy using.

I hope I've helped a bit and don't hesitate to ask if you want to know more, and I'm sure others will have more to help.

It can seem a frightening decision going onto any treatment, but sometimes you just have to get your head down dive on in and give it a go. You can always switch should something not work and more like I said is in the pipeline for the future.

EDIT: More can be found on the Bio treatments here: Biological Treatments For Psoriasis

[Kat]

Kat I'm afraid I'm not clever enough to give you any answers, you are an astute person and I'm sure you will decide for yourself what is likely to be "best" I think most of us can only advise on what we have tried and I think like you we give a biased view.
What you are doing at the moment works for many, but you have a feeling it's not doing it for you, and are rightly thinking of the next step......
I think the best person to guide you will be your dermatologist in conjunction with your insurer, as they seem to have the final say.
I'm sure that they have protocols they have to follow and you will,have to fail those before you can move on.
I was very lucky with my hospital it only took around forty years to get me on a medication that actually controls my psoriasis. I went through all treatments and had varying degrees of success, I won't say I've been covered all my life in psoriasis but it has always lurked and always came back in the winter
As I say it's no good me recommending my treatment as it's not available to you in America if it was I would recommend it highly as it is far less toxic than most treatments.
I'm sure others will be able to advise and point you in the right direction, but as I said at the start you are doing the right thing by researching now. Ready to go armed with some ideas.

I know the decisions will be made on many factors. Doctor recommendation, insurance, other health issues, etc) I'm not looking for recommendation, but rather am looking at opinions and hoping to gain a better understanding. I've read about the experiences of members in other threads, what I'm trying to do (I think lol) is to ask why you think your med (or others) is working for you. Why (for those who feel as such) they do not like the "other" option. And even if there are worries about the risk factor (that all meds have in some form). I'm not so much looking for an answer as to what is best for me, but what is best for anyone who is willing to answer and why they feel it is best for them. I'm trying to get a tad less scientific and a bit more personal opinion (which if based on science is great too!) And I'm hoping that I can learn a bit more about how these meds work too. Then when and if I have to have a discussion with my doctor, I hope that I have my own opinion to actually have a good discussion and not just take what the doc says as the final answer.

[Kat]

As you know I'm a big fan of the bio treatments, and that would be the way to go in my opinion. The main reason I say that is because they work fast, will give you your life back, are simple to take, and there are around 5 types with more in the pipeline.

Without boring you to much the basics are "Biologic drugs are made from living human or animal proteins. They are designed to treat psoriasis and psoriatic arthritis by targeting overactive cells in the body. Some biologics target a type of immune cell called T cells while others target the chemical messengers released by activated T cells." T cells in a person with psoriasis are over active, have a read of this thread for a simple explanation: T Cells the soldiers in your body

Yes you will see negative points about them as you will with any treatment, but mostly that comes down to your immune system will be a little weaker so you could be more susceptible to get infections or viruses. The flushes you mention are more associated with Fumaderm and not with the Bio's, the biggest risk is probably tuberculosis (TB) and you will & should be checked before stating them.

The worst I've experienced and I've tried them all apart from Simponi was a reaction which I had from Remicade and Humira, my body just didn't like them and I turned into a lobster. That was soon fixed with nice soothing baths in hospital and switching to Enbrel. I've had a few flu or cold like symptoms, mostly after starting but now my body is settled down to my current one Stelara I have no problems.

I agree you don't want it to be a debate and rightly so, as like you said what works for some may not work for others. But as for why I think the Bio's are a better choice for me and why I wouldn't use the others.

#1 The Bio's have given me my life back, and have been the best treatment I have ever had.
#2 They are easy to take with a simple injection under the skin (apart from Remicade which is given by infusion) this is a bonus for me as I hate taking tablets.
#3 The only tablet treatment I have tried was Methotrexate and I think you have read enough about my thoughts on that.
#4 I wouldn't try any of the other tablet form as I don't like the sound of the side effects, and I hate taking tablets.

I recently was considering Fumaderm as I've seen good result's and low side effects from members on here, but decided I don't like tablets and Stelara is still working very well so why change. plus it could always remain an option if needed later on.

At the end of the day you have to do what you feel is best for your body, and most importantly remain in charge of what you are happy using.

I hope I've helped a bit and don't hesitate to ask if you want to know more, and I'm sure others will have more to help.

It can seem a frightening decision going onto any treatment, but sometimes you just have to get your head down dive on in and give it a go. You can always switch should something not work and more like I said is in the pipeline for the future.

EDIT: More can be found on the Bio treatments here: Biological Treatments For Psoriasis

Thanks Fred and yes, that is what I'm looking for basically why a person likes their current treatment and info on why they think it works as well as any worries about side effects. Also why they would or would not consider going to another treatment. Going to check out your links (I'm pretty sure I've read them already but will read again as a refresher)

[Kat]

I see Fred's already replying. Think that will clear up and give information.
Maybe I will add to that later.

Thanks Caroline, I think you understand a lot of the scientific stuff associated with these meds. Admittedly, I don't have that understanding.

[Kat]

@Jim Thank you for your reply. Sorry I meant to say that in my answer to you. And you're plenty clever!

[jiml]

I can't tell you why my Fumaderm is working for me but I can tell you why I love it so much,
Before going on Fumaderm I was on topical,creams of one kind or another I ended up with dermovate which I believe to be the strongest i have used and I still,keep,a,tube beside me for emergencies.... I have suffered skin thinning mainly on my shins where I used to get psoriasis really badly and was constantly putting ointment on, the rest of my body has fared well with no adverse effects. I also keep,a,tube of Dovabet again just in case.
I have used Dovonex which had no effect on my skin whatsoever Dovonex is not a steroid it is a vitamin D derivative, but as I say did nothing for me
I used to have puva treatment which was a psoralen bath before UVA treatment it was great and cleared my skin, but it was an uphill battle and lasted a few months then returned..... When they told me no more phototherapy as I had a lifetimes doses already we had to look to the next step.
For me it was methotrexate which did a great job and cleared my skin. But I couldn't tolerate taking it as it made me feel so unwell,and nauseous. I couldn't face taking them in the end and they moved me onto Fumaderm what a great day that was. Caroline can tell you why it works, me I just know it works great for me
I had stomach/ intestine cramps to begin but now I never get them, I got hot flushes which are not unpleasant, and I still,get a few......I don't know if this helps or not

[mataribot]

I wouldn't worry too much about the side effects of biologics - you will properly monitored by your doctor (more so than the average person). I have been on and off them for years and I do not get sick anymore on them then off them.

I would choose the treatment the less restrictive to your daily life.