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The Pros and Cons of Biologics for Treating Psoriasis


Katherine Omueti Ayoade, MD, PhD

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FAQs About Moderate To Severe Psoriasis

Get to know the basics of psoriasis from a practicing dermatologist.
Woman talking to doctor

Biological medications are at the forefront of medical research and progress for treating chronic illnesses, including psoriasis, an inflammatory disease that can cause severe buildup of red, scaly plaques on the skin. But while these drugs are proven to successfully treat psoriasis, careful research and discussion with your provider is needed to determine if a biologic is right for you.

Biologics, unlike most traditional drugs, are not made from chemicals. Rather, they are genetically engineered proteins derived from human genes. They’re designed to target and block the specific components of a patient’s immune system that cause inflammation. Experts believe this inflammation leads to the development and exacerbation of diseases like psoriasis. Biologics are usually given through injections or intravenous infusions.

The Benefits of Biologics

The biggest statement in favor of biologics is their proven success rate. In clinical trials, all approved biologics for psoriasis achieved a 75% or higher reduction in psoriasis plaques. And with certain biologics, most patients saw these results in just 12 weeks of treatment. As a provider, it’s incredibly gratifying to see my patients improve considerably while on biologics, and I’ve even seen patients have their psoriasis plaques completely clear using these drugs.

Biologic medications have shown great success in helping psoriasis patients clear their skin. However, sometimes it’s necessary to switch to a new biologic—and that’s okay.

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But despite their success rate, I generally recommend a topical or oral medication first before trying a biologic. Because the technology used to manufacture biologics is cutting edge and the process is highly specialized, these drugs are very expensive. However, some drug companies offer financial aid and payment plans to help the patient obtain these much-needed medications in certain situations.

Biologics are a good treatment option if oral medications and topicals fail to suppress your psoriasis. I also bring biologics into the conversation earlier if psoriatic lesions already cover more than 10% of the patient’s body surface, or if the patient has psoriatic arthritis—when the disease spreads to the joints, causing pain and swelling. In this case, a patient would only need to take one drug to treat both psoriasis and psoriatic arthritis-–another benefit to trying biologics.

Since biologics are injected or given via infusion, some need to be received only 4 times a year or every 4 weeks. Having fewer medications to keep track of cuts down on compliance issues, which doctors say improves the chances your treatment will be more successful.

The Negative Side of Biologics

Besides cost, which can be exorbitant, the main reason you may not opt for biologics is if you already have an impaired immune system. Since biologics, by definition, target a person’s immune system, they can make the risk of developing life-threatening infections even greater. If you have cancer, HIV/AIDS, or a transplant, among other immune-suppressing conditions, your immune system may not be strong enough to fight off major infections; taking these powerful, targeted drugs with these conditions could lead to an active infection. That’s why prescreening exams are important to test for certain conditions that could preclude you from taking biologics.

The potential side effects of biologics are also an important factor in this discussion. Some common side effects include respiratory infections, flu-like symptoms and reactions at the injection site.

Prescreening for Biologics

If you and your physician decide it’s time for biologics, you will first take several baseline tests to determine if these drugs will be suitable for you. This prescreening process mitigates the risk for side effects and complications later on in your treatment. The baseline assessments include testing for prior exposure to tuberculosis (TB), hepatitis B and hepatitis C. If a patient has had tuberculosis, or been in an environment where TB is endemic (and thus could be at a risk for latent TB), I would advise that person to talk to his or her provider. In addition to testing for TB and hepatitis B and C, the screening exam should also test for blood cell count and liver and kidney function at baseline.

Biologics: Making Progress

Science and medicine in recent years have increased our knowledge of psoriasis, and this progress has led to better therapeutic options for our patients–like biologics. Physicians equipped to treat psoriasis can tailor the available treatments to your needs, ensuring the best possible outcomes in the care of your condition.

THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.

Katherine Omueti Ayoade, MD, PhD

Katherine Omueti Ayoade, MD, PhD, is a practicing board-certified dermatologist and instructor with the department of dermatology at the University of Texas Southwestern Medical Center. View her Healthgrades profile >

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© 2017 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

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