I recently sat down with my doctor to discuss the possibility of stopping my biologic or extending the dosing schedule. I began biological treatment in February 2021 with the drug Stelara (ustekinumab) and achieved partial skin clearance. After switching to Taltz (ixekizumab) in August, I have now achieved close to complete skin clearance.
Taltz involved several loading doses every two weeks before settling into an every-four-week cadence. However, due to issues with my insurance and specialty pharmacy, I waited six weeks between my most recent dose and the one that preceded it. I did not experience a resurgence of symptoms during the two-week lapse in treatment, so naturally, I was curious about the possibility of simply taking my new medication less often.
I have always had concerns about biologic use over time and have experienced side effects (increased infections) on this medication, both of which contribute to my desire to take it at extended intervals. I figured longer intervals meant less of the drug in my system over time. However, my new dermatologist quickly rejected this idea.
Although my doctor admitted there is not enough research on extending the period between dosings with my particular drug, her opinion was that this did not make sense for me. She had a few reasons.
First, my doctor wants me to have been on the drug for at least six months before making any changes. It is not totally clear to me why she feels this way, but it seemed to have something to do with wanting my body to enjoy clearance for a little bit longer before making any shocks to the system.
Second, my doctor is concerned that spacing out my shots farther than the prescribing information indicates could allow my body to build up an antibody response to the drug that would make it less effective. This was counterintuitive for me. My nonmedical, layperson hunch would have been that taking less medication would make my immune system less likely to learn how to bypass it. (Read more about building a resistance to biologics.)
Third, she shared that all of her patients who have begun and had success with biologic treatment have stayed on the drug indefinitely (so there is a lack of precedence for tapering).
Alas, I found myself agreeing to two more months of treatment at the prescribed four-week interval — at least until I hit the six-month mark.
My doctor remains open to tapering off the drug and seeing what happens after that, but she was more inclined to suggest I switch to a different biologic if I was unhappy. I recently switched practitioners, as my former dermatologist left the practice, so I don’t have a deep relationship with this doctor. However, I can’t say that I had one with my former doctor either.
The dermatologist appointments are quick and impersonal, and I always end up feeling like I leave with more questions. This may mean that I need to advocate for myself in a different way, but it also points to how confusing this disease is for patients and doctors alike.
I love having skin clearance, but I do not like the idea of being on any medication indefinitely. I also maintain interest in naturopathic treatments and don’t want to give up on this route, but I know that I’ll never be able to gauge their effectiveness while on biologics. I still have a lot to think about, but I will follow my doctor's recommendation and continue my course of treatment until the six-month mark — when we will revisit the conversation.
MyPsoriasisTeam columnists discuss psoriasis from a specific point of view. Columnists’ articles don’t reflect the opinions of MyPsoriasisTeam staff, medical experts, partners, advertisers, or sponsors. MyPsoriasisTeam content isn’t intended as a substitute for professional medical advice, diagnosis, or treatment.