What supplements can patients on biologics (biologic medications) take to boost their immune system?

Supplements for Immune Support in Patients on Biologics

There are no recommended supplements that can safely boost the immune system for patients on biologic medications, as these could potentially interfere with treatment efficacy or increase infection risk.

Understanding Biologics and Immune Function

Biologic medications used in conditions like psoriatic arthritis (PsA) and other autoimmune diseases work by specifically targeting components of the immune system, such as:

• TNF inhibitors (TNFi)
• Interleukin-17 inhibitors (IL-17i)
• Interleukin-12/23 inhibitors (IL-12/23i)
• Other targeted biologics (abatacept, tofacitinib, etc.)

These medications intentionally suppress specific immune pathways to control inflammation and disease activity 1.

Key Considerations for Patients on Biologics

Infection Risk

• Biologics already increase the risk of infections, particularly TNF inhibitors
• Patients on biologics have a statistically significant higher rate of tuberculosis reactivation (OR 4.68) compared to controls 2
• Certain biologics like certolizumab pegol are associated with significantly higher risk of serious infections 2

Potential Interactions

• Supplements marketed as "immune boosters" could theoretically:
  • Interfere with the mechanism of action of biologics
  • Potentially trigger immune activation that counteracts the therapeutic effects
  • Increase risk of adverse events or drug interactions

Management Recommendations

For Patients with Recurrent Infections

If a patient on biologics is experiencing recurrent infections, consider these evidence-based approaches:

1. Evaluate switching biologic class:

   • Consider switching to abatacept which has been associated with fewer serious infections compared to TNFi, infliximab and tocilizumab 2
   • For patients with severe or recurrent infections, consider IL-12/23i or IL-17i biologics over TNFi 1

2. Infection prevention strategies:

   • Ensure appropriate vaccination status before starting biologics
   • Consider prophylactic antibiotics in high-risk patients
   • Practice good hygiene and infection prevention measures

For Patients Concerned About Immune Health

Instead of supplements, focus on evidence-based approaches to support overall health:

• Maintain good nutrition through a balanced diet rich in fruits and vegetables
• Regular physical activity appropriate to the patient's condition
• Adequate sleep and stress management
• Smoking cessation if applicable
• Appropriate vaccination according to guidelines for immunocompromised patients

Common Pitfalls to Avoid

1. Self-medicating with immune-stimulating herbs or supplements that could potentially:

   • Interfere with biologic efficacy
   • Trigger disease flares
   • Increase infection risk through unpredictable immune modulation

2. Delaying reporting of infection symptoms - patients should promptly report fever, persistent cough, or other signs of infection

3. Assuming all "natural" supplements are safe - many can have significant biological activity and potential for drug interactions

Conclusion

While patients may be interested in supplements to "boost immunity," there is no evidence supporting the use of any specific supplement to safely enhance immune function in patients on biologics. The focus should be on optimizing the biologic therapy, preventing infections through standard measures, and maintaining overall health through lifestyle approaches rather than supplementation.