Biologics treat rheumatoid arthritis (RA) by targeting parts of your immune system that fuel inflammation. These medications work very well to slow down RA and alleviate pain, swelling, and other symptoms. So why give up a good thing? There are some reasons why you may need to discontinue taking a biologic.
One reason may be that the medication you are taking does not alleviate your symptoms. Side effects are another reason to stop these medications.
„There is an increased risk of infection, and sometimes the infection is so severe that the biologic needs to be temporarily discontinued,“ says Dr. Nilasha Ghosh, a rheumatologist at the Hospital for Special Surgery.
Other side effects like nausea or headaches may not be as severe. However, they can significantly impact your quality of life, leading you to consider discontinuing the medication.
Sometimes, you don’t need a permanent separation from your biologic, but you need a short break. There are several reasons why you may need to temporarily discontinue these medications.
You are sick. Biologics suppress your immune system to prevent it from attacking your joints, but this also prevents it from fighting off germs during an infection.
„When they get sick, we play it safe,“ says Dr. Rebecca Haberman, a rheumatologist at NYU Langone Health. „We stop the medications so that their immune system has the time to fight off the bacteria or viruses.“
You are getting vaccinated. There is evidence that biologics may reduce your response to vaccines, although most people who are vaccinated while taking biologics receive sufficient protection. You and your doctor can decide if you should discontinue taking your biologic until you have received a vaccine, says Ghosh.
You are having surgery. For a minor procedure like removing a skin cancer lesion, you do not need to stop taking biologics. However, your doctor may recommend discontinuing your biologic for a few weeks before an open surgery like knee or hip replacement because these medications can increase your infection risk.
You are pregnant. Pregnancy is not a reason to completely avoid biologics. However, you may need to switch medications. Certain biologics like Adalimumab (Humira) and Certolizumab (Cimzia) are safer for a growing baby than drugs like Golimumab (Simponi) and Rituximab (Rituxan).
Even if you are not comfortable with the idea of taking medication during pregnancy, it is a good idea to continue taking them. „If a patient is suffering from active RA, it is likely safer for her and her baby to continue taking a biologic than to endure pregnancy with a lot of inflammation and pain,“ says Haberman.
You are feeling better. The goal of taking biologics is to achieve remission. Once you have reached remission, you can try taking a break from the medication. However, be aware that your symptoms may recur.
„When patients stop a biologic, it can lead to a worsening of their arthritis symptoms or a disease flare,“ says Ghosh. If you have more severe rheumatoid arthritis at the outset, the likelihood of your symptoms recurring may increase.
In a study, individuals with stable RA who discontinued TNF inhibitors had about three times higher risk of experiencing a disease flare within the next 12 months compared to those who continued their medications. However, nearly half of the people in this study were able to stop their biologic without further symptoms.
One way to reduce the risk of disease flares is to slowly taper off these medications. You can do this in two ways: decrease the dosage or extend the period between doses.
„There is a subgroup of patients who can taper off their medications and stay in remission,“ says Ghosh. While your doctor cannot accurately predict if you will experience a disease flare again, research shows that the likelihood of the disease subsiding without relapse is greater if you:
- Are taking a biologic for the first time
- Are young
- Have been in remission for a long time
- Are not taking steroids
- Have a lower level of C-reactive protein (CRP), a blood marker for inflammation
The good news is that in case of a flare, resuming a biologic should stop the symptoms.
Whatever the reason you may want to stop your biologic, involve your doctor in the decision. It’s never a good idea to discontinue a medication on your own.
Discontinuing biologics could lead to a flare-up of your arthritis. A relapse not only affects your quality of life but could also lead to further joint-damaging inflammation, says Ghosh.
If your symptoms have not improved with your biologic or if you are experiencing side effects, you have other options, says Haberman.
„If you come to your doctor and say, ‚I really can’t tolerate this,‘ he will work with you to find the medication that you can tolerate,“ she says. „Because the best medication for you is the one you take.“