I'm ready to call it. Otezla is in it's death spin if it hasn't reached total shit can status. I made exactly 1 year. Seriously it was on day 366 I woke up and I swear I heard those pesky ninja ballerina elephants stampeding out of my room and leaving me feeling like fresh road kill. Well road kill undoubtedly feels better because well, it's dead. It's been a nice break from the stampede. Sure there's been days that I had a duo or trio of elephants tap dancing on my joints, but not the whole damn herd. They'd gone on vacation for the most part. Oh well, it's not like the first time or the last I will be at this point of fun at the circus that is Psoriatic Arthritis. My beloved super power/kryptonite wouldn't be doing it's thing if it wasn't keeping me on my toes.
So as I've officially failed all TNF~Alpha biologicals and DMARDs approved by the FDA at this point it's time to research the newest greatest best thing since sliced bread options. I don't know if I mentioned this in the blog, but I reached toxicity with Lefludemide in October so that was my last DMARD option. I shared it on the Facebook page, but in all honesty it was one of the most miserable not pain related experiences I've had in a long time. You think opioids make you constipated you've never met the med that flushes Lefludimide. ANYWAY If you want to know message me and I'll be happy to share the misery that is that awesomeness of torture. Point being I am out of DMARD options.
So here are the options, drum roll please......
Cosentyx. FDA approved for both Psoriasis(Jan 2015) and Psoriatic Arthritis(Jan 2016) This is a IL-17 inhibitor. The newest trend in biologicals and the first to target this particular protein. It is also approved for Ankylosing Spondylitis. It is a monthly injection with a loading cycle of 4 doses spread a week apart and then every 4 weeks after that. It seems to have all the typical horror story reading when it comes to potential side effects and death.
Taltz: FDA approved for Psoriasis (March 2016) in Phase 3 trials for Psoriatic Arthritis with positive indications. This option would require bringing Dermatology into the mix until it is approved for PsA. It is also a IL-17 inhibitor. Loading schedule is a double dose at day 0, then regular dose every 2 weeks through week 12. Then standard dosing of every 4 weeks after that. Again pretty standard potential side effects and maybe death.
Siliq: FDA approved for Psoriasis (Feb 2017). Another option that would require Dermatology cooperation. Another IL-17 inhibitor. Dosing is injection weekly for first 3 injections and then every other week for normal dosing. This one has a black box warning for suicidal ideation and behavior. Beyond that side effects are similar to the others. No current information on FDA trials for PsA.
There you have the options and a little info on the newest meds in the last year that are not listed on the other medication blog posts. I see the Rheumatologist Friday for our little come to Jesus powwow. She always loves when I get to this point. If anything I have some hope that with it being a totally new inhibitor that is really focused on Psoriatic disease that possibly it will be my miracle. I could use a few or 5 or 10 years on a steady pharmaceutical regime.
One final note. If any of you decide to take Siliq or Otezla both have warnings for mood altering from mild to extreme. Please be aware of your emotional state and health at all times, but especially when taking these meds that have increased potential for issues. I have a signed medical release in my file that if I am acting in a way that is dangerous to myself or others I have 3 designees who have authority to commit me for observation and treatment without my consent. I trust these 3 people completely to have my best well being at heart. Fortunately it hasn't been needed, but it relieved a stressful concern for me that I had someone who was aware of my behavior if I ever reached a point that I was not aware of myself.
I hope this finds you all in the best condition you can be in. Take care of you! You can't pour from an empty pot.