Who Should NOT Take Biologic Medications?
Biologic medications are a very effective treatment option for people with moderate to severe lupus, or those who have not responded to other therapies. Although biologic medications have seen great success in treating lupus, they do not come without side effects and are not an appropriate fit for every lupus patient.
What factors make someone a poor candidate for biologic treatment?
People with active bacterial, viral, or fungal infections and those who are prone to severe infections should not take biologic medications. Biologics suppress a targeted part of the immune system, which can make it more difficult to fight off bacterial and viral infections. In addition, those with latent or chronic infections like tuberculosis or Hepatitis B should undergo careful screening before taking a biologic medication as they can reactivate when the immune system is lowered.
People with a history of severe allergic reactions to biologic agents or their ingredients should avoid that medication and carefully consider other options, alongside their physician.
Those wanting to become pregnant or who are pregnant should have a conversation with their doctor about starting a biologic medication. Safety data in pregnant women on biologic therapy is limited and requires careful consideration by you and your physician.
Any lupus patients with other conditions such as heart disease, cancer, inflammatory bowel disease, certain psychiatric conditions, other autoimmune diseases, or any other chronic condition should work with their physician to determine the best course of treatment and whether biologic medications would be of benefit.
Lupus patients are generally advised not to take any live attenuated vaccines. This is especially important for patients taking biologic therapies as weakened immune systems may not be able to handle the live virus safely.
So, who should take biologic medications?
In addition to universal baseline hydroxychloroquine treatment, the European Alliance of Associations for Rheumatology (EULAR) and the American College of Rheumatology (ACR) both recommend the early initiation of biologic therapies for systemic lupus patients who do not respond to standard treatment regimens and to lower the need for long-term use of steroids.
For active lupus nephritis patients, ACR recommends a combination of biologic and immunosuppressive therapy alongside minimized steroid dosing.
Prior to taking any new medication, talk openly with your healthcare provider about what to expect – including side effects and what makes you a good candidate for that treatment regimen. Having honest conversations with your doctor ensures you stay informed and actively engaged in building the best treatment plan for your care.