How Taking Two Biologics Simultaneously Is Working Out for Me

I started taking a second biologic to treat my eczema and asthma at the end of last year. My allergist and dermatologist had recommended I begin Dupixent (dupilumab) injections about five years ago, when my eczema became difficult to treat. But initially, I hesitated.

I’m familiar with biologics to treat psoriasis. The first biologic approved by the Food and Drug Administration for psoriasis, Amevive (alefacept), became available in 2003, and now there are 15 of them, according to the National Psoriasis Foundation. Over the past 22 years, I’ve tried six, including my current biologic, Skyrizi (risankizumab-rzaa).

I intimately know the apprehension of starting a new medication, and thankfully, my psoriasis has responded well to Skyrizi, with few side effects.

The thought of starting a second biologic, however, raised many questions and concerns:

• Would it help my eczema and not worsen my psoriasis?
• Would dual biologic therapy increase the chance of side effects?
• And knowing how much biologics cost, how would insurance respond to another request for an expensive treatment?

Six months into taking two biologics, I can begin to answer these questions.

Would Insurance Pay for Two Expensive Medications?

While it’s far from a funny situation, I chuckled when my dermatologist brought up taking Dupixent.

I already have a challenging time getting insurance to cover Skyrizi more frequently than typically prescribed — every 8 weeks instead of 12. Every time I call for a refill, some issue with insurance coverage seems to pop up.

In my imagination, I saw my health insurance provider denying my request for a second biologic that would also cost tens of thousands of dollars a year. I feared that the denial would come after starting therapy with samples from my doctor.

However, a week after my doctor submitted a prior authorization request for Dupixent, I received an approval letter. Good news!

For some reason, though, adding the new biologic complicated payment for Skyrizi. Getting that worked out took many phone calls and added layers of frustration. It never feels easy dealing with insurance issues, but I’m glad I’ve had the chance to try the two biologics with little out-of-pocket cost.

Is the Second Biologic Working?

When I started taking Dupixent, I hoped it would be a wonderful post-Christmas gift wrapped in a neatly designed injector pen. At the 16-week mark, a common endpoint for clinical studies, I experienced mixed feelings.

To my relief, Dupixent did not exacerbate my psoriasis. My allergist had read case studies where psoriasis either started or worsened for people taking Dupixent. That possibility concerned me enough that I put off trying it for a few years.

While I didn’t find my body covered in eczema patches like it had been in the winter, the itchiness and pink-to-red patches didn’t completely go away. My dermatologist had also hoped that I would have a stronger response to the medication.

With less-than-stellar skin clearance, my dermatologist and I considered switching me to another eczema biologic. A new adverse effect made the decision for us.

Am I Having Increased Side Effects?

Initiating Dupixent therapy felt like jumping into a dark hole without any visibility. I didn’t know anyone who could tell me their experience of dual biologic treatment for psoriasis and eczema. The little information I could find on the internet looked promising but didn’t match my situation exactly.

Case studies like this one reassured me some, but I was apprehensive since what works for one person might not work for me.

My doctors shared why they felt comfortable prescribing the two biologics together. They explained how Skyrizi and Dupixent have unique mechanisms in blocking immune system inflammation pathways. As a result, taking them together might not increase the risk of adverse effects.

I felt relief when blood tests came back normal. But then a reported Dupixent side effect came on suddenly: eye inflammation. Within a couple of weeks, I was in my ophthalmologist’s office. He messaged my dermatologist with his recommendation that I stop Dupixent.

What’s Next?

Today I’m patiently waiting for yet another insurance approval for the next eczema biologic, Adbry (tralokinumab-ldrm). Adding Dupixent felt scary and new. Dual therapy with it and Skyrizi didn’t work out as well as I had hoped, but I no longer fear the unknown.

In fact, I’m hopeful that adding Adbry to the treatment mix will be just the right formula to reduce skin inflammation. I’ll be sure to let you know how it goes.