What to Expect With Biologics for Psoriasis


Marijke Vroomen Durning, RN

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You may have seen advertisements on television and in magazines over the past couple of years telling you of new medications available to help people who live with moderate-to-severe psoriasis. These medications are part of a newer class of drug called biologics, and they’ve benefited lots of patients. Before you ask your doctor about them, it’s important to know what biologics do and how they could help you.

For more severe cases of psoriasis, typical treatments aren’t always enough.

Many people who have been diagnosed with psoriasis will tell you that it’s much more than a skin condition. In fact, psoriasis is actually an autoimmune disease. When your immune system works properly, it targets and kills invading cells, such as bacteria and viruses. But with autoimmune diseases, your immune system starts to attack its own cells. In the case of psoriasis, it consistently attacks the skin cells, causing chronic inflammation. On the outside, psoriasis can be very uncomfortable and affect many aspects of your life. The red, raised, itchy or painful plaques (patches) that develop can crack and bleed, increasing your risk of getting an infection. Psoriasis can also be embarrassing and isolating if plaques are obvious to others.

Mild cases of psoriasis can often be managed with lifestyle changes and treatment with creams and ointments, but if you have moderate-to-severe psoriasis, these topical treatments may not be enough. Psoriasis that affects from 3 to 10% of your body is called moderate psoriasis. If the plaques cover more than 10% of your body, this is considered severe psoriasis. Systemic treatments, therapies that affect the whole body and suppress the immune system, are usually the next step in treatment if topical options don’t help. Systemic treatments are given by pill, injection or intravenously (via an IV). But if systemic treatments aren’t effective or if you also have psoriatic arthritis (a condition that can affect people with psoriasis), your doctor may recommend that you take a biologic, which is also called immunotherapy, because it engages and selectively modifies the immune system. In some cases, doctors will skip systemic therapy and go straight to biologics.

Biologics can help manage moderate-to-severe psoriasis. 

Unlike systemic therapies which suppress your entire immune system and thus minimize inflammation, biologics enhance your immune system by targeting specific immune cells.

Biologics block the signals between immune system cells and the pathways that create inflammation, preventing the psoriasis plaques from developing. The biologic drugs currently approved by the U.S. Food and Drug Administration (FDA) include secukinumab (Cosentyx), etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), golimumab (Simponi), ustekinumab (Stelara), and ixekizumab (Taltz). These are administered either by IV or injection, and many can be taken at home.

Biologic therapy is not a cure.

Biologics aren’t a cure for psoriasis and they can’t reverse any damage that may have occurred, such as joint damage from psoriatric arthritis; however they can help relieve the symptoms and reduce the risk of any further damage. How long you stay on the treatment depends on how well you respond to it, as well as if you experience any side effects or develop other health issues that might affect the medication.

Not everyone can take biologics.

Biologics can increase your risk of contracting infections, so some people should not take these medications. You may not be a candidate for a biologic medication if you have a compromised or weakened immune system, or if you have an active infection. Your doctor will ask that you be tested for tuberculosis before you start taking the treatment. If you test positive for the disease, you will have to be treated before you can start biologic therapy. Once you do begin taking the medication, you will be asked to undergo regular blood tests to ensure that the medication is right for you and is not causing damage to any organs.

Biologic therapy does have side effects.

As with all medications, biologics do have some side effects. The most common ones are pain at the injection site, flu-like symptoms, and respiratory (lung) infections. More serious side effects are rare but may include multiple sclerosis, seizures, inflammation of the nerves of the eyes, blood disorders, heart failure, and certain types of cancer.

The field of biologic therapy is promising for many people with moderate-to-severe psoriasis. If you are interested in learning more, ask your doctor if this treatment is right for you. Biologic medications can be expensive, though. If you are a candidate for a biologic, check with your insurance provider to see how much of the medication’s cost would be covered. Some pharmaceutical companies do provide assistance for people who do not have the funds to cover the costs.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Dec 23, 2016

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Medical References

  1. Psoriasis. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/psoriasis/basics/definition/con-20030838
  2. Moderate to Severe Psoriasis and Psoriatic Arthritis: Biologic Drugs. National Psoriasis Foundation. https://www.psoriasis.org/about-psoriasis/treatments/biologics
  3. About Psoriasis. National Psoriasis Foundation. https://www.psoriasis.org/about-psoriasis

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