Switching Biologics for Axial Spondyloarthritis

People may switch the biologics they take for axial spondyloarthritis (AxSpA). They usually have a good reason for making this change. Still, there is much to consider before swapping. Weighing the benefits and costs listed below can help you see if switching biologics is right for you.

Why do people switch biologics?

People with AxSpA who switch biologics often do so to achieve better results. The biologic they take may not work well. Biologics can also become less effective over time.1-3

A person who has side effects while taking a biologic may try something else. A study showed adverse effects were the main reason people switched from tumor necrosis factor inhibitors (TNFi) for ankylosing spondylitis (AS). In another study, people with inflammatory arthritis and ulcerative colitis switched biologics because of adverse effects or because the first biologics they tried stopped working as well.2,3

Side effects with a new biologic can even cause a person to switch back to the biologic they took at first. A study reported this occurring in up to 1 in 4 people. Several studies found this switch-back occurred a lot with people who replaced Enbrel® (etanercept) with Benepali® (SB4).2

Sometimes people switch biologics because of changes in the drug itself or access to the drug. Drug makers may put a generic biologic on the market. They may also take a biologic off the market.1

The cost of drugs also has an impact on people’s decision to switch biologics. A study found that most people switch from TNFis to biosimilars, which may cost less. A person may also opt to try another drug if their health insurance no longer covers their current biologic.2

How many people switch biologics?

According to 1 study, 1 in 4 people taking TNFi for AS made a change in the first year. After 5 years, less than half of these people were still taking the TNFi they started with. Of those, 63 percent were taking another biologic, and 30 percent had stopped anti-rheumatic treatment.3

Another study looked at almost 800 people with AS who had just started a biologic. Out of those, 15 percent switched biologics in the first 12 months. Nearly 32 percent stopped taking biologics in that same timeframe.1

Is switching biologics safe?

Most people can safely switch biologics. But some fare worse than others.2

At first, switching biologics may lead to an increase in symptoms. The full benefit of these drugs tends to come over time, but the symptoms can show up right away. One study showed that people stuck with each new biologic for less time.2

Another study showed that people who switched biologics for AS needed more healthcare. They went to the doctor more often. They also made more trips to the emergency department.1

The outcome from switching biologics varies from person to person. Some respond better when they shift from an older to a newer biologic. Choosing the right biologic is key. Starting the new biologic as soon as you can after stopping the last one can also have better results.4

Is switching biologics costly?

Switching biologics can cost you more. You may lose money if you switch before you finish a biologic for which you already paid. And you will incur the costs of paying for something new.2

A drug that works better for you may be worth the extra expense. But switching biologics does not always lead to better results. One study showed that people with AS who switched biologics needed more doctor visits and more prescriptions.1

When a person switches biologics, costs also increase for health insurance payers. They pay for each person’s first biologic. And then they pay for the other drugs people switch to.1

Switching biologics may save money for certain people. This may happen if you take biosimilars in place of biologics. Biosimilars are similar to biologics but often come at lower prices.2

People with AxSpA can safely switch biologics and improve as a result. But certain people who swap biologics may get worse and need more healthcare. In either case, healthcare payers and the people who switch biologics both spend more money.1

If you have AxSpA, starting with a biologic you can continue long-term is best. Talk to your doctor about which biologic to take first. Your doctor can also help if you want to switch biologics for some reason. They can review your health history and suggest which other treatments might work well for you.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The AxialSpondyloarthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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