When a Drug Fails: Advice on Starting a New Treatment
I have been on a biologic for my psoriasis since 2014. It was the second one I tried and it cleared me tremendously. Going from 90-percent covered with psoriasis to only having some spots on my legs, I have never felt so liberated in my entire life. For the first time in 21 years I was able to wear the clothes I wanted without fearing what people would think. (Check out another article I wrote two years ago, "Clear Skin Brings New Fears.")
Unfortunately, my stint of clear skin had an expiration date, and one of my biggest fears became a reality. In July 2015 I noticed my medicine wasn’t working as well as when I first started it, and have since realized that I made a lot of mistakes during my journey to a new treatment. I'm sharing these insights in hopes of helping others avoid those same mistakes.
I stopped taking my medicine without my doctor's knowledge
After I noticed my body had become used to medicine, I decided to discontinue it without speaking with my doctor first. Visiting my doctor eight months after stopping my medication, I realized my mistake. Honestly, I had simply grown tired of having to deal with medicines and thought the break would allow my body to reset. I had also decided to go on a gluten-free diet. (Read more about my experience.)
After four solid months of no medicine and maintaining a gluten-free diet I was 90-percent covered with psoriasis again. And the stress of the disease seemed to affect me more this time around than it had before, when I didn’t know what life with clear skin was like.
I encourage you to be your own advocate, but if you believe your current medicine isn’t working, talk to your doctor before you discontinue its use.
I thought I needed a break before starting a new treatment
I was under the assumption that I needed to be off my medicine for at least three months before starting a new drug. I was so wrong. My doctor advised that I could have started a new medicine within one month. The timeframe varies, depending on how long a drug remains in your system.
Before starting a new treatment, speak to your doctor about any current medicines you're using.
If you take a break from a medicine, it may not work as well the next time
I was advised by my physician's assistant that after taking a break from a medicine, when/if you decide to return to it the drug might not work as well as it did initially. This is an issue I am facing right now. Had I known that, I would have not stopped my medicine, but would have continued to use it until I could create a game plan of next steps. My medical team also advised that they could have given me my doses every two months instead of every three to help with my flares. When I first started my treatment, I was virtually clear in three weeks. Now I am in my third week of my first round since last October, and there has not been much improvement in my skin.
Here are some things you need to think about before switching medicines:
Side effects: Every drug has its own set of side effects. Talk to your doctor about new side effects you may face by switching your medicine.
How often you will need the new drug: Consider how much time you have for a new medicine. Some require everyday use, some once a week, some once a month, and some every three months. Some drugs require lab work to ensure there are no side effects. Be sure to speak with your doctor about the time it will take to use a new medicine, because it could be far different from what you are currently experiencing.
The approval process and cost: How long will it take your insurance company to approve the medicine? Does the doctor have samples on hand that you can use? How long will it take the patient assistant program to kick in? These are all questions you need to ask your doctor.