Can we stop biologic medication and achieve permanent remission in autoimmune diseases?

This question is commonly asked by patients. No one likes to take a medication unneccessarily and once a person feels well, it a not uncommon to want to see if they can stop their medication.  In the case of an autoimmune disease, the body is genetically programmed to want to overproduce inflammatory chemicals and therefore stopping treatment will likely result in a return to active disease. Some patients will not be able to achieve the same level of effectiveness when they try to return to treatment. There is a small group of patients however, who when treated with a biologic and methotrexate at very beginning of their diagnosis could achieve a remission state.

The issue is that in Canada, in order to receive an advanced and expensive therapy such as a biologic, you need to try several less expensive medications first and so biologics being used immediatley at diagnosis does not happen. Some specialists are looking at reducing the frequency of a pateint’s medication once they have been symptom free for a year on their treatment regimen. In rheumatoid arthritis patients, reducing the dose may be more practical when rheumatoid factor is not present and in patients who have shown a quick response to biologic treatment and have had minimal joint dammage. When the rheumatoid factor is found to be positive in the blood, reducing the dose will likely not provide the same benefit.

The main message is to not stop your treatment when you are feeling well, but rather ask if you are a candidate to reduce your dosage. Not everyone will be able to manage on a reduced dose and this should only be done gradually and only with physician consult.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health.  Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

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