Biologics and immunosuppression

Hi, My 15 year son has been on cyclosporine & is now on methrotrexate. I don’t like him being on any of them tbh but his dermatologist said that he has to try them &. Them to fail before he can try biologics . So I’m also wondering what they are like the same as you. I am also worried about him going onto them at such a young age but he needs something, he’s missed so much school this year because of the flare on his face 😢

@mt382, you may be correct in your assumption that biologics have less side effects than mtx or cyclo but similarly they can have harming effects and hence the reasons for regular blood tests. If you are under an NHS dermatologists you will be very fortunate/lucky or your P/PsA is so severe that they may bypass the systemics options. Not normally the case though even with a strong argument why should go straight to biologics. Your consultant will have to put a case forward why systemics aren't an option to convince the funding authorities. As for immunosuppression, I think it is a matter of going about your normal activities but looking after yourself around others especially around poorly people. That may be more problematic as a medical student. Basically means you are more vulnerable If you were to fall ill and it may take longer to fight the illness/infection. I personally have had a few infections that have required medical intervention/antibiotics and they all cleared up thankfully. I caught Covid once about a year ago, so was very careful who I mixed with during the main covid period. I didnt have any symptoms other than testing positive so wasnt bad with it. That was my experience anyway. Good luck.

Thank you - I know historically that dermos massively gate keep biologics but I suppose I had hoped that with their relative decrease in price that might have ended. It's horrible - a skin condition can have such a negative effect on someone's psychological wellbeing before you even get to the dangers of having active inflammation in an enormous organ, nail issues, joint involvement etc, yet there's still thus reluctance to treat. I have colleagues with Crohns, for example, who were able to side step methotrexate and other systemic tablets with ease and go straight to biologics. Learning about metho and cyclo in medical school has honestly only furthered my disdain for trying them. They really are like taking a hacksaw to cellular function :( oh well. Fingers crossed I am able to argue with enough conviction and stand my ground. Hard to tell where my psoriasis is in terms of severity as I have a home NB UVB UNIT. It generally covers most of my lower legs, knees, upper arms, with extensive finger and knuckle involvement. Very little on the torso however. It also returns pretty much to baseline if I miss a nb uvb treatment so it's quire aggressive. I think they might bow to methotrexate now, but perhaps as you say not to biologics. NICE guidance says that emotional wellbeing and impact on QOL should feed into prescription decisions though?

@mt382. Following this reply and in another thread. As I mentioned consultant's can bypass the normal medical procedures if they think the patient is better off straight on to biologics. How often that happens for P anyway I wouldn't know. With your involvement in medical school you probably learn about a wide range of practices and medications, many that could have serious side effects but with monitoring the patient can cope well on them, if not they stop and alternative arrangements found. Now playing devil's advocate here I wish you luck trying to convince your dermatologist to prescribe biologics but you could be missing out on an improved quality of life by not agreeing to systemics if they are offered. If they fail you would be another step closer to biologics anyway. In an ideal world biologics could be prescribed to all that have moderate to severe P and yes prices are falling with new biosimilars available. I still think you have a fight to convince the authorities to put you straight onto biologics. On your description of side effects of home NUVB maybe that is now doing more harm than good. Have you informed your dermatologist about the home usage and side effects?

Just as a followup - I saw the private dermatologist today. I was quite candid about wanting biologics. She said outright that I only really needed to try one systemic before that, and agreed to start acitretin. She said she'll review me in four months and if my psoriasis isn't clear I'll go straight to biologics. Exciting!

My experience on cyclosporine wasn't great, first time in hospital with Erythredermic psoriasis last year I get covid, then mrsa so had to come off it, then onto acetretin which controlled my symptoms but didn't improve it. Dermatologist then decided to give a lower dose of cyclosporine a go but a few weeks in I had to come off it again as my bp was going up and up. Now I'm just about to start second biologic so fingers crossed this works. Personally speaking I wouldn't go back on cyclosporine but like all these meds they work for some.

Hello again. So my son has now had his first 2 injections of amgevita a lbiomaster for humeria & looks & feels so much better, skin seems to be improving already too.. we are so much happier &!hopefully now he can move forward with his life x

I was fine on cyclosporin, but couldn't take methotextrate. The NHS protocol is usually to try the cheaper options before biologics.

I have been on the biologic, Bimzelx, for around 5 weeks and it completely cleared my psoriasis in 2 weeks. I had to try Cyclosporine first but had terrible headaches and weird hot/cold sensations in my fingers so stopped taking it after 6 weeks. I’ve just picked up a cold, so will see how long it takes to recover vs normal! No side effects of Bimzelx so far. Very pleased with it, but it took 6 months from initial consultation to start the drug after first trying Cyclosporine.