People with psoriasis know that creating a good plan to manage symptoms can be challenging. This chronic, inflammatory skin condition can be difficult to treat. What works for one person doesn’t necessarily work for another. Even after years of trial and error with topical or sometimes more aggressive systemic medications, patients can feel really frustrated if they are only seeing minimal improvements in their skin disease. Biologics offer a more effective treatment solution for many people who struggle to manage chronic psoriasis symptoms. Learn more about biologic therapy for psoriasis in our blog or talk to your dermatologist about this treatment option at your next visit.
What are Biologics?
As you may deduce from the name “biologics,” these medications are made from biological matter rather than chemicals and other synthetic substances commonly found in other types of drugs. Biologic therapies may also be called simply biologics or biological treatments. They are used in a variety of situations to change the immune system’s response to certain stimuli. Specifically, biologics are a systemic therapy used to modulate the production of cytokines, the body’s messengers that trigger inflammatory response. By introducing a targeted biologic agent to your system, the inflammatory response that causes psoriasis is inhibited, preventing or diminishing the symptoms of psoriasis.
In the past, immune-suppressing drugs have been used to help individuals with very severe cases of psoriasis, but these medications weaken the overall immune system, leaving individuals at higher risk for infection and other serious health concerns. For this reason, immune-suppressing medications were not considered an ideal, long-term solution for psoriasis treatment.
Unlike general immune suppression drugs, biologic therapy can be used to precisely pinpoint the specific immune response that is causing health concerns. For psoriasis sufferers, that means we can provide a medication that is geared toward preventing their specific psoriatic symptoms.
Are all Biologics for Psoriasis the Same?
Currently, there are five categories of biologics on the market used in the treatment of moderate to severe psoriasis and psoriatic arthritis, and the categories are defined by what immune responses they inhibit. Specifically:
- Tumor Necrosis Factor-Alpha Inhibitors (TNF-Alpha Inhibitors)
- Interleukin 12/23 Inhibitors (IL-12/23 Inhibitors)
- Interleukin 17 Inhibitors (IL-17 Inhibitors)
- Interleukin 23 Inhibitors (IL-23 Inhibitors)
Within each category, there are several different biologic therapies available. Dosing, efficacy, and treatment plan will vary based on the individual and the specific biologic drug being used. Currently, dermatologists will prescribe one of the following 13 biologic therapies for psoriasis and psoriatic arthritis:
Adalimumab (Brand Name Humira)
- TNF-Alpha Inhibitor
- Approved to treat plaque psoriasis and psoriatic arthritis
- Medication administered via self-injection every other week
- Adverse effects include infection and increased risk for certain cancers and autoimmune disorders
- Not recommended for individuals with autoimmune disorders, heart failure, or multiple sclerosis
- Alternative medications include biosimilars Adalimumab-atto (name brand Amjevita) and Adalimumab-adbm (brand name Cyltezo)
Etanercept (Brand Name Enbrel)
- TNF-Alpha Inhibitor
- Approved to treat plaque psoriasis and psoriatic arthritis
- Medication administered via self-injection twice a week for 3 months then once a week
- Adverse effects include skin rashes and irritations
- Not recommended for individuals with autoimmune disorders, generally weakened immune system, multiple sclerosis, hepatitis B, or heart failure.
- Alternative medications include biosimilar Etanercept-szzs (brand name Erelzi)
Certolizumab Pegol (Brand Name Cimzia)
- TNF-Alpha Inhibitor
- Approved to treat psoriasis and psoriatic arthritis
- Medication administered via self-injection two shots on day one, at 2 weeks, and at 4 weeks; then, two doses every four weeks or one dose every two weeks
- Adverse effects include signs of infection (fever, chills, fatigue, cough, etc.) and skin redness, swelling, and discomfort
- Not recommended for individuals with multiple sclerosis, inflammatory autoimmune disorders (Crohn’s disease, ulcerative colitis, etc.)
- Alternative medications are currently being tested for usage and may be available soon
Infliximab (Brand Name Remicade)
- TNF-Alpha Inhibitor
- Approved to treat plaque psoriasis and psoriatic arthritis
- Administered during intravenous treatment sessions (each visit will last 2 to 3 hours) with doses delivered two weeks and six weeks after the initial treatment; then, doses will be administered every 8 weeks
- Adverse effects include respiratory infections, stomach pain, coughing, and headaches
- Not recommended for individuals with tuberculosis and may increase the risk for the development of tuberculosis or people who have recently received a vaccine or will need to within the next year
- Alternative medications include biosimilars Infliximab-dyyb (Inflectra) and infliximab-abda (Renflexis)
Ustekinumab (Brand Name Stelara)
- IL-12/23 Inhibitor
- Approved to treat plaque psoriasis and psoriatic arthritis
- Administered via self-injection one shot is given 4 weeks after the initial treatment, and ongoing usage requires injections every 12 weeks
- Adverse effects are rare but serious and include increased risk for cancer and reversible posterior leukoencephalopathy syndrome
- Not recommended for people who have recently received a vaccine or will need to within the next year; women who are pregnant, breastfeeding, or actively trying to become pregnant; or for those who are receiving allergy treatment
- Alternative medications are currently being tested for usage and may be available soon
Secukinumab (Name Brand Cosentyx)
- IL-17 Inhibitor
- Approved to treat plaque psoriasis and psoriatic arthritis
- Administered via self-injection of one dose a week for five weeks followed by monthly dosages
- Adverse effects include cold or infection symptoms, upset stomach, diarrhea
- Not recommended for individuals with tuberculosis and may increase the risk for the development of tuberculosis
- Alternative medications are currently being tested for usage and may be available soon
Ixekizumab (Brand Name Taltz)
- IL-17 Inhibitor
- Approved to treat plaque psoriasis and psoriatic arthritis
- Administered via self-injection of one dose every 2 weeks for 12 weeks; then one dose every 4 weeks
- Adverse effects include upper respiratory infection, fungal infection, upset stomach, and nausea
- Not recommended for individuals with tuberculosis and may increase the risk for the development of tuberculosis
- Alternative medications are currently being tested for usage and may be available soon
Brodalumab (Brand Name Siliq)
- IL-17 Inhibitor
- Approved to treat plaque psoriasis
- Administered via self-injection of one dose a week for three weeks; then one every other week
- Adverse effects include suicidal ideation, depression, and mood instability
- Not recommended for individuals who have a history of depression and suicidal thoughts without monitoring and approval from a mental healthcare provider
- Alternative medications are currently being tested for usage and may be available soon
Risankizumab-rzaa (Brand Name SKYRIZI)
- IL-23 Inhibitor
- Approved to treat plaque psoriasis
- Administered via self-injection of two doses four weeks apart followed by doses every 12 weeks
- Adverse effects include injection site reaction (rash, bruising, discoloration), upper respiratory infection, fatigue, and headache
- Not recommended for individuals with tuberculosis and may increase the risk for the development of tuberculosis
- Alternative medications are currently being tested for usage and may be available soon
Guselkumab (Brand Name Tremfya)
- IL-23 Inhibitor
- Approved to treat plaque psoriasis
- Administered via self-injection with one dose administered 4 weeks after the initial dose; then, one dose is administered every 8 weeks
- Adverse effects include upper respiratory infection, upset stomach or diarrhea, joint pain or swelling, headaches
- Not recommended for individuals with tuberculosis and may increase the risk for the development of tuberculosis
- Alternative medications are currently being tested for usage and may be available soon
Tildrakizumab-asmm (Name Brand Ilumya)
- IL-23 Inhibitor
- Approved to treat plaque psoriasis
- Administered via self-injection with a dose administered 4 weeks after the initial treatment; then, one dose is administered every 12 weeks
- Adverse effects include signs of infection (fever, chills, cough, fatigue), muscle aches, upset stomach or diarrhea, and shortness of breath
- Not recommended for individuals with tuberculosis and may increase the risk for the development of tuberculosis
- Alternative medications are currently being tested for usage and may be available soon
- Not recommended for individuals with chronic infections, tuberculosis, COPD, hepatitis B, or skin cancer; it’s also not recommended for individuals who have recently received a vaccine or will need vaccination within the next year
- Alternative medications are currently being tested for usage and may be available soon
When are Biologic Therapies Used? Am I a Good Candidate?
Many treatments for psoriasis are geared toward managing the skin or joint symptoms. However, biologics additionally work to address the underlying causes of psoriasis – inflammation. In doing so, they can decrease a patient’s overall inflammatory load and improve comorbid conditions which can arise in psoriasis, including increased risk of heart attack, stroke, kidney/liver damage, etc. If patients struggle to achieve and maintain clearance with other topical psoriasis treatments, biologics are a good option. Side effects are uncommon on patients treated with biologics, but they can occur. We work with patients to ensure their psoriasis is managed safely and effectively.
Biologic drugs may be effective therapies for individuals with moderate to severe psoriasis who aren’t managed effectively with other treatments. Consider your answers to the following questions when determining whether or not biologic therapy is right for you:
1 – How Severe is Your Condition?
It’s easy to say that covering a certain percentage of the body makes psoriasis moderate or severe. Some professionals say 10% coverage is considered severe. However, poorly managed psoriasis on the hands, feet, or other sensitive areas can be just as painful, so your dermatologist will evaluate the severity of your symptoms on a case by case basis. If your psoriasis symptoms negatively impact or impede your ability to function, your condition is probably severe enough for biologic treatment.
2 – Are You Experiencing Adverse Effects from Your Current Treatment?
Most people have only mild reactions to psoriasis treatments, but if you’re one of the few patients who have more severe reactions to traditional psoriasis medications, biologic treatment may be a better option.
3 – How Healthy are You in General?
Because biologics suppress immune function, there are certain conditions for which your doctors may elect to not start a biologic medication or not start certain classes of biologic medications. Your physician will speak to you more about some of these special circumstances.
4 – Do You Want to Save Time?
Many psoriasis treatments require frequent trips to the dermatologist, daily applications, and constant attention to symptoms and triggers. Biologics can often be administered on your own at home, and they are usually only taken a few times a year after an initial round of treatments. However, you will have to give yourself injections, which can be difficult for some patients.
5 – Does Insurance Cover Your Treatment?
In most cases, your insurance benefit plan will only cover biologic treatment if you’ve tried other, less expensive treatment first. For this reason, your dermatologist will likely prescribe other therapies to ensure you can maximize available coverage.
Do Biologics Cure Psoriasis?
Biologics are systemic therapies that work to normalize your immune system functions and address underlying cause of psoriasis. Those responses that lead to the inflammation, development of plaques, and other skin and systemic symptoms of psoriasis are being stopped at the source by biologic treatment without suppressing your whole immune system. Right now, these treatments don’t completely cure psoriasis, but they are considered safe for long term management.
Ready to Find Out More About Biologic Treatment?
When you’re ready to learn more about biologic therapy, U.S. Dermatology Partners would love to hear from you. Simply take a few moments to complete our online request form, and one of our friendly team members will be in touch to schedule your session.
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