If you don't mind me asking, what was your like on Remicade (and/or what you swapped to)? I suppose I have the option of taking a biologic (not Remicade) for an immune mediated condition, but I can't help but shake the feeling that the cure might be worse than the disease in my particular situation.

I don't mind at all! I started on Humira, switched to Remicade, now on Skyrizi. Remicade worked better than Humira for me, but it's a much stronger drug (and I worked my way up to a higher-than-default dose), so I was prone to some weird skin infections that I hadn't had on Humira despite both drugs acting on the same mechanism, and my immune system was weaker overall. Nothing serious, just annoying. And I wasn't actually responding that well to Remicade overall.

But Skyrizi has been way more effective so far and had almost no side effects, knock on wood. I say "almost" because I've had some different, milder skin infections (mostly seborrheic dermatitis) that I can't say for certain were caused/exacerbated by Skyrizi, but either way it's miles better than active Crohn's disease so I'm not complaining!

Obviously it depends on your particular condition and the drug in question, but my take is that unmediated immune dysfunction is worse for you 99% of the time than the side effects of any biologics used to treat it. (That calculus changes if we're talking about non-biologic options like methotrexate or steroids though, lol.) For example, when I was on TNF inhibitors, those come with a black box warning about how you might have a slightly higher risk of developing cancer while taking them... but that risk is still far lower than the inherent cancer risk from unchecked intestinal inflammation. Plus the fact that drug-induced cancer is (1) not a guarantee and (2) something you have a chance of beating, whereas choosing to suffer without effective IBD treatment would doom you to certain suffering and a very high likelihood of permanent bowel damage, etc.

Different drugs just have very different impacts, too. Even though I took Remicade and Skyrizi to treat the same condition, the latter is an older drug with a shotgun-ish approach to immune suppression (even more so than Humira); Skyrizi is much newer and more like a sniper rifle. Newer isn't always better, but monoclonal antibodies in particular have come a long way even in the past decade or so, and I'm optimistic they're only gonna get better and better. I actually just read this the other day, which you might find interesting! https://worksinprogress.co/issue/how-to-make-an-antibody/

Thank you for your response.

I'm prone to weird skin infections already, so no telling what would happen to me lol. Then again, my AI condition is some psoriatic variant. However, I technically classify in the mild category -- body surface < 2%. Topicals don't really work well for me considering my variant kind of look like mild chicken pox. I'm in a weird camp because treatments seem to have very little effect, yet I am not truly severe enough to warrant biologics. My doctor essentially gave me an offer, and her words were near verbatim, "You can keep using topicals and whatnot and never be completely clear, or take Skyrizi, be 100% clear, and stop wasting your time."

I chose the first option as dumb as it may be. Worrying might be my main personality trait at this point in life, and something about the biologics do not sit right with me. I am less worried about the cancers and more about the increased risk of infections. I suppose one detail I left out prior was that my entire condition was triggered after an infection 10 years ago. Plus, with all the ever growing research surrounding Long COVID, how Shingles vaccines seem to correlate with a reduction in dementia, etc. I am not certain infections are something that should just be casually dismissed as a benefit that is worth the risk. Though, I believe this only for my situation. You have to understand that my condition causes me zero functional impairments nor does it prevent me from doing anything I want to do in life. I imagine a vast majority of people on biologics could not say that same (without biologics).

That article was fascinating! Thank you for sharing it.

That all makes sense! If your skin stuff is relatively mild and isn't causing you too much trouble, a topical approach seems warranted (and is certainly a lot cheaper). That said, if it ever does get worse to the point where you're in genuine distress, keep in mind that the psoriasis-only dose of a drug like Skyrizi is a lot lower than the big fat dose I take for Crohn's disease, and less frequent as well. Also keep in mind--and hopefully it doesn't come to this--that psoriasis is highly comorbid with both Crohn's/colitis and arthritis, so if you start to experience worsening digestive issues or joint pain, definitely get those checked out. The silver lining is that if you do experience comorbidities like that, finding the right treatment (usually but not always a biologic) can knock them all out at once.

(For your current situation, you might also want to look into other biologics like Dupixent or Xolair, which can also help with skin conditions have different effects/trade-offs that might be more within your risk tolerance!)

> that psoriasis is highly comorbid with both Crohn's/colitis and arthritis

2/3 of my biggest fears in life lol. The other being some form of dementia. I have had worsening digestive issues, albeit this was something I had prior to the psoriasis disease.

Honestly, I keep trying to hold out for as long as I can -- not that I am under really any pressure. With each year that passes, better treatments come out. So, if I can make it a decade longer, then who knows what treatments will look like then?

Do the injections hurt? I am not afraid of shots, but I do not know if I can give myself one. I'd need like 3 shots of whiskey and a rag to bite down on, and then I might be able to do it. Hope alcohol doesn't interact with the medications (I don't drink much normally).

In my experience the injections are very mild and easy to administer. As a kid I used to be afraid of becoming diabetic because I didn't think I'd be able to give myself insulin shots, but now I give myself a number of shots without issue. For most of these drugs, including lower-dose Skyrizi (like a "psoriasis only" dose), it's an auto-injector pen almost like an EpiPen where you just pinch the skin, press down, and a spring engages with minimal pain/effort. You don't even see the needle! And then my higher-dose Skyrizi is unique (as in, I've never seen any other biologics that do this, but it might become more popular) in that you actually stick a little plastic box to your leg/stomach for a few minutes that administers the dose for you. Again, you never have to see the needle, and there's a bit more sensation than a pen-style injection but it's mostly from the fact that the injection takes so long to complete (compared to a pen that takes 15-30 seconds from start to finish). Icing the area beforehand can help, too.

I will also say there's truly never been a better time to be diagnosed with an autoimmune condition, given the quality and number of treatments available these days. For Crohn's and colitis in particular, if you catch it early enough and find a treatment that works for you, I believe it's possible to prevent the worst of the permanent damage so long as you remain in remission or mild-at-worst inflammation. Compare that to twenty years ago when there were only a few treatment options, which made it much harder to get in remission, which increased your odds of needing surgery or similar.