Tell me about biologic medications

[athena1277]

Dh has lots of sinus issues and has had 2 sinus surgeries in the last 4 months (and more in years past).  His ENT wants to put him on Dupixent help to keep him from getting sinus infections all the time.  I saw that it’s a biologic, but I really don’t know what that means.  How does it work?  What are the pros and cons of this type of medicine?  Due to Covid restrictions, I am not allowed to go with him to his appointments and he never thinks to ask many questions.

[prairiewindmomma]

Biologics are a broad category of medications. Biologics are made from proteins and other natural sources. Most drugs that we take are actually chemical synthetics.

Biologics target different aspects of our immunoresponse. Typically, biologics are either TNF (tumor necrosis factor) inhibitors, IL (Interleukin) inhibitors, B-cell inhibitors or T-cell inhibitors. 

Dupixent (dupilumab) is a monoclonal antibody that blocks IL-4 and IL-13.  It's typically aimed at eczema but it is used for those with chronic sinusitis. It's injectable subcutaneously (which is way easier to give yourself than intramuscular, in my opinion). 

Because it's a biologic, making it is complicated, and it's expensive.  Definitely check your insurance benefits and manufacturer's coupons.  Biologics are also often super picky about storage conditions, so many people on those have a backup plan on how to handle their medication if power is lost to the home, and so on. 

[prairiewindmomma]

I forgot to add--Dupixent isn't an immunosuppressant in the traditional sense. It's not toxic to the liver. It's not a steroid.

As far as biologics and most medications go, it seems to be really gentle on the system.

I haven't taken Dupixent, but I brush up on what's out there every 6 months or so because biologics are where most of the up and coming stuff is in the autoimmune world.

[athena1277]

17 minutes ago, prairiewindmomma said:

Biologics are a broad category of medications. Biologics are made from proteins and other natural sources. Most drugs that we take are actually chemical synthetics.

Biologics target different aspects of our immunoresponse. Typically, biologics are either TNF (tumor necrosis factor) inhibitors, IL (Interleukin) inhibitors, B-cell inhibitors or T-cell inhibitors. 

Dupixent (dupilumab) is a monoclonal antibody that blocks IL-4 and IL-13.  It's typically aimed at eczema but it is used for those with chronic sinusitis. It's injectable subcutaneously (which is way easier to give yourself than intramuscular, in my opinion). 

Because it's a biologic, making it is complicated, and it's expensive.  Definitely check your insurance benefits and manufacturer's coupons.  Biologics are also often super picky about storage conditions, so many people on those have a backup plan on how to handle their medication if power is lost to the home, and so on. 

So do you take it long term?  What happens if you come off it?  Dh is bad about deciding medication isn’t working or forgetting to take it.  

[prairiewindmomma]

Usually with Dupixent you take an initial two shot dose, and then you take as a shot every 2 weeks or every 4 weeks. (Most biologics are on some sort of weekly/every 2 week/monthly schedule. It's not a daily thing.)

Usually biologics are a long-term thing. If you think about it, you're taking medication to stop an immunological response problem. If you aren't taking the thing to stop it, then the problem is going to start up and keep happening again.  Maybe he'll get lucky and he'll go into some sort of immunological response remission, but that tends to be on the less likely end of things.  This is a question for his doctor, though, as I really don't know about its use from chronic sinusitis.  My personal background is on the rheumatology side of things with some adventures in eczema and asthma. 

I think the point is, this type of medication is usually expensive enough that you only continue it if you see really good results.  If he doesn't see a strong improvement, then I don't know that it's a good choice for him. I mean, pre-insurance, we're talking something like $1500/shot. Generally you have to do some hoop jumping to get insurance to cover it. Dupixent has a manufacturer's coupon/copay program, and I wasn't kidding about looking into it. 

[TravelingChris]

I am on Dupixent as well as Enbrel.  Dupixent is for my asthma but it has definitely helped with my  eczema and I haven't hadsinusissues either.  But I think my sinus issues were most helped by getting the two pneumonia shots.

[momto3innc]

My son has been on dupixent for a year for nasal polyps. We actually are getting it for free from Dupixent after sending them our financial info (and while we don’t make a ton, we certainly have enough—I was surprised at getting it free). There is no possible way we could afford it—it is so expensive and our insurance would not approve it. He takes it every two weeks. I inject it for him into his arm. We get an overnight refrigerated box delivered once a month with two shipments. He has had no side effects from it.

[Anne]

Next time he has an appointment, have him call you and put you on speaker so that you can hear and ask the pertinent questions.  I have many friends/family that do this for the benefit of having more input at a medical appointment.

Anne

[athena1277]

1 hour ago, Anne said:

Next time he has an appointment, have him call you and put you on speaker so that you can hear and ask the pertinent questions.  I have many friends/family that do this for the benefit of having more input at a medical appointment.

Anne

I wanted to do this for one of his post surgery appointments because he was on heavy painkillers, but he refuses.  Not really sure why.  

[kokotg]

I don't know a ton about it, but my DH is on a biologic (taltz) for psoriasis, and it's been absolutely life changing for him. No side effects that he's noticed; I've been worried with covid, but he had his antibodies tested after his first 2 shots and he had them, and then he had a booster early on because he's on an immunosuppressant (and he hasn't gotten covid, despite teaching high school in person since fall 2020). He did stop taking his taltz for a couple of months right around his covid shots as a precaution. Our insurance didn't want to pay for it at first (and it would be completely unaffordable without insurance), but the drug company gave it to him essentially for free for the first year or whatever and then the insurance approved it (I guess because he had evidence that it had worked? they didn't refuse to pay for any biologic, but they wanted him to try a cheaper one first. But taltz is specifically for psoriasis and was what his dermatologist recommended). 

[Pawz4me]

Because biologics are so expensive I believe most insurance companies require that patients have tried and failed some other treatments first. At least that's the way it was for my RA (I'm assuming your DH has already done that). After a couple of first line type drugs didn't work there was apparently no trouble getting me an approval for Enbrel. Or I assume there was little/no trouble--my rheumy's office handled getting the approval, I didn't have to do anything. You'll definitely want to look into the manufacturer's co-pay assistance program. Enbrel's is very good. For me it pretty much works out that they fully pay for my first two months of medication for the year, and that amount covers the max out of pocket for my insurance. So after my February prescription is filled I have no other medical costs for the year (other than premiums, of course). Also, I've always had to get Enbrel through a specialty pharmacy, and I believe that's standard for these types of medications. The first insurance I had when I was on it only allowed the use of one specialty mail order pharmacy. They overnight shipped it, and it worked fine. My current insurance allows me to choose between several specialty pharmacies, and the one I chose is affiliated with our hospital system, and I can either have it shipped or pick it up. If your insurance allows a choice I'd do a little research--some specialty pharmacies are definitely better than others.