Biologics vs. Infusions for Psoriatic Arthritisby Julie Cerrone Croner Patient Advocate
The first time I heard that I’d have to be self-administering injections into my own skin, I was nervous. Sure, I was excited to be trying a new drug that may help me control my out-of-control psoriatic arthritis, but giving myself an injection was not something I was used to. Now I found myself faced with giving myself bi-weekly self-injections.
There were many thoughts that went through my head. What if I couldn’t do it myself? What if it really hurt? What if I couldn’t push the button? But, when it came down to it, I knew I HAD to do it. If this was going to make me feel better I could suck it up and stab myself.
When my first self-injecting pen of medication came, I remember sitting on my couch giving myself a pep talk. I had been through the process with the practice pen and was ready (ok, more like my parents told me I was ready) to take the actual injection. I started sweating from every place there was to sweat in my body. I had no idea what to expect, and that was terrifying to me! With the pen in hand, I took the cap off and began to count down.
3, 2, 1 . . . sike!
Ok, ok this time I’ll do it.
3, 2, 1. . . 1. . . 1. . . ahhhh I can’t do it!
By the 5th count down, I bit the bullet, pushed the trigger and to my surprise didn’t feel a THING. No pain, no burning, NOTHING. For a split second I was mad at myself for getting so worked up about it, until I looked down at my leg and realized that the injection hadn’t even left a mark. Upon closer examination, I realized that I had been using the practice pen! All that agony and I hadn’t even been holding the REAL pen!
I took the REAL pen out of the fridge, set it on the counter to warm up, and spent the next half hour laughing at myself. With chronic illness, you have to learn to laugh at yourself, right? Once it was warmed up, it only took me 2 count downs to pull the trigger and finally inject myself with the pen.
Self-Injections vs. Infusion
At that time, I wasn’t familiar with the different biologics and didn’t realize that some were self injectables and others were administered through an infusion. And since then, they’ve even started marketing biologics in pill form!
There are many different factors that go into choosing which biologic is right for you. Some patients prefer receiving an infusion because they know that they do not want to give themselves an injection. While other patients would rather self-inject, on their own time.
There are several pros and cons for both self-injection and infusion biologics. The decision for which biologic is right for you is truly a decision that should be made between you and your doctor. But remember, you do have a say, so educate yourself in order to make the right decision for you.
If you are taking a self-injecting biologic, you will be required to administer the injection weekly, bi-weekly or monthly, depending on your dosing schedule and the specific biologic you’ve been prescribed. For instance, I started on Humira bi-weekly, but after a year bumped up my dosage to weekly because I felt the medication wearing off by the second week. Other examples are Enbrel can be administered weekly or twice weekly, Simponi can be given monthly and Stelara is usually given twice in the first 4 weeks and then every 12 weeks thereafter.
Self-injecting biologics can come in auto-injector pens or prefilled syringes. With the auto-injector pens, you’re only required to uncap and press the trigger button to activate the injection. The prefilled, single-use syringes are administered just like a regular shot you’d get at the doctor's office. In either application, the needle will penetrate your skin and deposit the medication just under your skin.
I’ve had the experience of injecting myself with auto-injector pens (Humira) and also prefilled syringes (Lovenox, not a biologic, but they’re packaged the same way.) My personal preference is for the auto-injectors. The needles are hidden, there is less room for error, and they aren’t as “scary” looking as the syringes.
When my biologic was first prescribed to me, I was given a practice pen at the doctor's office and a nurse came in and showed me how to do it. I was really happy to have the practice pen at home because in the heat of the moment I started to forget everything the nurse had told me! Each of the biologic drugs come with some sort of starter kit to help make your experience as easy for you as possible. They have many different programs that you can take advantage of as well. For instance, with Abbvie, they offer text alerts to remind you when to take your Humira injection and a travel case incase you have to take your injections on the road.
If I could offer my advice when it comes to self-injecting, I’d give you the following tips:
Make sure to take the biologic out of your fridge to warm up for a half-hour before administering.
When you inject, pinch a good section of your skin at the injection site.
Rotate your injection sites and don’t administer it in the same place each time. I used to rotate between my thighs and my abdomen.
While a self-injected biologic is performed at home on your own time, infusions will take a bit more of your time. You will be required to travel either to your doctor’s office, the hospital or an infusion center to receive your medication. The location will depend on your doctor and health plan. Each infusion time depends on the actual biologic which is being administered, but you can plan on spending a few hours for each infusion.
When you arrive for your appointment, you’ll be prepped and then administered the actual biologic drip. Your drip time will depend on the biologic. For instance, Orencia can be administered within 1 hour, with Remicade taking 2 hours. Again, just like the dosing for a self-injectable, this will be determined by your doctor.
Unlike the self-injecting biologic, which deposits the medication directly under your skin, an infusion deposits the biologic directly into your blood system. This typically means that if you’re going to have a reaction to the medication you’ll notice it right away. The nurses at the infusion location are trained to help you identify these and assist you if any complications arise.
Depending on the biologic, infusion schedules vary. You can receive them either monthly, every 6 to 8 weeks or every 6 months, depending on the prescribed biologic. For instance, Remicade is administered in 3 treatments in the beginning and then at a regular interval of every 8 weeks thereafter.
Self-Injections And Infusion Tips
Before I started my current medication, I reached out to several patients to ask for advice. Having never done this before, I wasn’t sure what to expect and what to do! Here are a few tips I’d like to leave you with:
Before you start your medication, research and empower yourself with knowledge on the drug.
Look into the medication assistance programs that exist for each of the biologics. They can help you afford the high co-pays.
Take advantage of the programs each of the pharmaceutical companies offer. For instance, the free personalized support services that Enbrel offers or the Humira ambassadors provided by Abbvie.
Stay up to date on the specific biologics FDA approved for psoriatic arthritis.
Deciding which biologic is right for you is an important conversation you should have with your doctor. Which ever you end up on, know that these drugs are currently the best medicinal option out there for combating your psoriatic arthritis. You’re in the company of many wonderful, thriving patients!