Choosing a Treatment for Autoimmune Disease

Episode 1: Conventional-Style

So you have a shiny new autoimmune diagnosis.  What comes next?

Drug therapy for autoimmune disease is no one trick pony.  Treatments vary widely and can focus on treating the symptoms, suppressing the immune system, moderating the pain, or all of the above.  For many patients, the treatment plan starts at the shallow end of the drug spectrum and slowly creeps deeper as autoimmune symptoms progress (insert big-pharma-conspiracy-theorist rant here).

Roids.

Steroids are a frequent first base.  They are used to halt active autoimmune flares and can be breathtakingly, life-savingly effective.  Unfortunately, in difficult cases, some patients are kept on steroids for months at a time, resulting in weight gain, acne, sleep troubles, and a tiny little temper fuse.  Another downside of steroid prescription is that with use, people can become resistant to them; what was first a godsend cure is suddenly as useless as a band-aid.  In this case, alternative types of steroids, higher dosages, or IV intervention may be required.

 What you thought steroids did vs. how you actually feel.

What you thought steroids did vs. how you actually feel.

Kryptonite for your Immune System

Immunosuppressants or immunomodulators are the next stop.  These drugs broadly inhibit the immune reaction in the body, helping it to CHILL OUT with the angry inflammatory symptoms.  The drugs do not work instantaneously, but take time to build up in the body before their effectiveness kicks in.  For this reason, they must be taken daily to avoid sneaky flare-ups and are not especially tolerant of skipped dosages.  

The list of possible side effects is long, with the most vanity-triggering one being hair loss, and the most common being nausea, stomachache, vomiting, and diarrhea- in some cases, the same symptoms they're meant to treat!  Ah, medical irony.  With long term use, immunosuppressants leave the body at risk of infections, with a tiny increased risk of lymphoma and skin cancer.  For this reason, it's important to test white blood cell counts regularly when taking these drugs.

Biological Warfare

Then we have the big guns of the autoimmune drug therapy worlds.  These drugs are called biologics and include familiar names like Humira and Remicade.  Instead of a broad immunosuppressant effect, biologics work by targeting specific proteins involved in the inflammatory response.  They can be incredibly, quickly effective, but come with their own set of baggage.

One heavy piece of luggage is the convenience factor.  Instead of a pill, most biologics are either injected or infused.  This may mean a daily shot at home or a monthly visit to a clinic for a blood infusion.  Either way, it's a lifestyle change with a high-stakes commitment; these drugs also no not tolerate skipped dosages.

 If this doesn't scream biological, I don't know what does.

If this doesn't scream biological, I don't know what does.

Similarly to traditional immunosuppressants, biologics increase the patient's risk of infections from a variety of sources due to lowered immunity.  The big scaries are tuberculosis and skin cancer, although the increase in risk is quite low.

Another factor to consider with biologics is the question mark on their long term effects.  As relative newcomers to the drug world, studies are lacking on this topic.  Most types are a mere 20 years old, but often come with a prescription for life.  This is because if a patient stops taking a biologic, their body can develop antibodies against it, making it useless for future use.  I remember well the frustration we felt when my husband's doctor pushed strongly for him to begin a biologic treatment that we felt was unnecessary.  It would have required monthly infusions and came with a concerning "final destination" sort of warning; if it didn't work, we were told we'd be waving goodbye to a large portion of his colon.  Thanks, doctor.

For those who tend towards big pharma conspiracy theorems, there is plenty to explore with biologics.  They're expensive, heavily advertised, and can be seen "trending" in various offices or for certain conditions.  We once witnessed a representative for one type of biologic asking a receptionist why patient X (he referred to her, incredibly, by name) was no longer taking said drug.  I don't know how many HIPPA regulations were violated for that conversation to take place within ear shot of a waiting room but I imagine it was a pretty long list.

 The answer is... um.

The answer is... um.

So you're saying... ?

At the end of the day, drug therapy for autoimmune disease is a very personal decision.  There are times when drugs are necessary and lifesaving.  Then there are times when they're prescribed and pushed unnecessarily.  For some, the ease of medication is worth the minor risk of side effects.  For others, it's more valuable to learn how their body interacts with diet, lifestyle, and environmental choices.  The important take-home is that options abound in autoimmune treatment and results vary no matter which path.  Doctors are excellent for guidance but self-research and homework is required.  If you're in the autoimmune boat, take time to reflect on your body, your priorities, and your particular options before choosing your adventure.  In upcoming posts, we'll explore some alternative ways to approach autoimmune disease therapy.