Psoriatic arthritis (PsA) is a chronic, inflammatory form of arthritis that affects joints and ligaments in the hands, feet, or back. PsA is an immune-mediated disease that occurs when the immune system mistakenly attacks the body’s own tissues. This attack leads to tissue damage and inflammation that can cause pain, swelling, and stiffness in the joints.

The goal of PsA treatment is to reduce the underlying inflammation. Doctors treat many people with PsA using a class of medications known as biologic disease-modifying antirheumatic drugs (DMARDs), which they commonly refer to as biologics.

Biologic DMARDs are highly specific medications that target the key causes of inflammation in PsA to reduce symptoms. However, in some cases, people who are receiving biologic therapy may want to stop their treatment.

This article looks at why some people may wish to stop biologic treatment for PsA. It also discusses the potential effects of treatment interruptions and considers the alternative steps that people can take to avoid stopping treatment.

People may wish to discontinue their biologic treatment for PsA for a variety of reasons. Some possible reasons for wanting to stop treatment include:

  • the resolution of symptoms
  • dissatisfaction with the results of treatment
  • intolerable side effects
  • pregnancy or anticipated pregnancy
  • upcoming surgery
  • cost-related concerns

Although treatment discontinuation may be necessary in some cases, healthcare professionals generally recommend that people with PsA on biologic therapy do not discontinue treatment without first consulting their rheumatologist to understand the potential risks and benefits.

The effects of stopping treatment with a biologic in PsA will depend on the specific type of medication.

Researchers recently reported the findings of a first-of-its-kind study on the effects of biologic withdrawal. Of the 394 participants with PsA, 158 people achieved minimal disease activity status for more than 3 months while receiving the biologic medication ixekizumab (Taltz).

The researchers then randomly assigned these 158 individuals to treatment withdrawal or continuation of treatment with ixekizumab. Of those who discontinued biologic therapy, 85% experienced symptom relapse within 2 years, compared with 38% in the group who continued treatment. Relapse also occurred more quickly following treatment withdrawal, occurring within 22 weeks, on average.

Although this was the first study that specifically described the effects of biologic treatment discontinuation, the findings of early studies on other biologic medications also suggest that relapse occurs quickly after stopping treatment for psoriatic disease.

Restarting treatment may help some people achieve disease control again, but others will find that treatment is not as effective as it was before.

Another potential issue of stopping treatment for biologics is that immunogenicity can occur. Immunogenicity refers to the development of an immune response in the form of antibodies against the medication.

Although studies on the immunogenicity of biologics in PsA are limited, research involving people with inflammatory bowel disease suggests that the development of immune responses against biologics may be more common with dose interruptions than with continuous use.

However, overall, the research suggests that immunogenicity to biologics in psoriatic disease is rare. Therefore, this is unlikely to be a concern regardless of whether a person stops treatment.

In general, experts recommend that people should not stop biologic treatment unless doing so is necessary.

As biologics treat PsA by suppressing the immune system, it is possible that their use during surgery may leave people more vulnerable to infections.

Due to this, healthcare professionals may recommend temporarily interrupting treatment, for as little as one dose, before any planned surgeries. They generally make such recommendations on an individual basis, taking into account the potential risk of infection and recent PsA activity.

The immunosuppressive effects of biologics also mean that the medical community recommends that people with active symptoms of COVID-19 stop treatment with these drugs until they have recovered.

In some cases, people may also need to stop biologic treatment while pregnant or if they plan to become pregnant. However, this will depend on the type of biologic they are taking.

Although research on the effects of biologic therapy in pregnancy is limited, there is some evidence that the use of certain biologics is associated with increased occurrence of complications in pregnancy, including pregnancy loss.

However, the American College of Rheumatology notes that based on current research, most rheumatologists will recommend continuing anti-tumor necrosis factor (TNF) medications throughout pregnancy and lactation.

In some cases, the symptoms of psoriatic disease may become worse during pregnancy. If necessary, some experts suggest that people can continue biologic therapy during the first and second trimester of pregnancy but should discontinue it during the third trimester. This allows the safe delivery of live vaccines during the first 6 months of the baby’s life.

The decision of whether to continue biologic treatment for PsA during pregnancy needs discussing on a case-by-case basis. The individual should involve all members of their healthcare team.

If a biologic does not control the symptoms of PsA, a rheumatologist may suggest adding on another therapy rather than stopping the initial therapy, which may cause the symptoms to become worse.

Combination therapy with another kind of systemic therapy may help achieve better disease control.

People who wish to stop biologic treatment due to the side effects may benefit instead from a dosage reduction, which usually reduces the side effects without completely removing the benefits of treatment.

Although the evidence supporting dosage reductions in PsA biologic therapy is limited, doctors often get good results from using this practice in other autoimmune conditions. People should not make any changes to their dosage without first consulting their healthcare team.

If cost is a factor in the reason for stopping, a person can work with their rheumatologist and pharmacist to research options for reducing the costs. They may also be able to find discounts through services such GoodRx or manufacturer programs.

Stopping biologic therapy for PsA may be necessary in some instances, such as before and during pregnancy, prior to surgery, and during active viral infection. In general, though, doctors do not recommend discontinuing treatment with a biologic, as doing so leaves people vulnerable to relapse.

Before stopping treatment with a biologic medication for PsA, a person should consult a rheumatologist, who can suggest alternative options to provide better treatment control or reduce the side effects of treatment. If cost is a significant barrier to treatment, healthcare professionals can also help people navigate the reimbursement resources available from pharmaceutical companies.