Psoriasis treatment: Biologics

Biologics are newer, stronger medicines. A biologic can target, or quiet, only the part of the immune system that is overactive because of psoriasis. This means that biologics have less risk of causing problems with the liver, kidneys, and other organs than do other strong psoriasis medicines.

Why do dermatologists prescribe a biologic to treat psoriasis?

A biologic is an important treatment option for people with moderate-to-severe psoriasis, psoriatic arthritis, or both. For many people, taking a biologic was life changing because it helped control their symptoms when other treatments failed.

Benefits of biologics

Using a biologic to treat psoriasis (or psoriatic arthritis) is life changing for some people.

Biologics work by blocking reactions in your body that cause psoriasis and its symptoms. If you have psoriatic arthritis, a biologic can stop the pain, stiffness, and swelling in your joints. It can prevent the arthritis from worsening and causing more damage to your joints.  The US Food and Drug Administration (FDA) has approved the following biologics to treat adults with psoriasis or psoriatic arthritis. In many cases, these biologics have been approved to treat both diseases.

¹Approved to treat adults when other psoriasis treatments fail to work or stop working.

Sometimes, a biologic is prescribed to treat a child who has psoriasis. This can be very effective for a child who has severe psoriasis.  The FDA has approved usetekinumab to treat people 12 years of age and older who have moderate-to-severe psoriasis.

Safety and effectiveness

Safety: Overall, the biologics have a good safety record. 

A patient’s risk of developing a serious infection remains the biggest concern. For this reason, dermatologists carefully screen each patient before prescribing a biologic. 

You’ll need to have some medical tests before your dermatologist can tell whether a biologic can be prescribed to treat your psoriasis. Blood tests and tuberculosis (TB) testing are typically required. Some patients need additional medical tests. 

Effectiveness: Studies show that the biologics approved to treat psoriasis and psoriatic arthritis can be very effective. For many people with moderate-to-severe psoriasis or psoriatic arthritis, a biologic may offer the most effective treatment available. 

If you take a biologic continuously, it tends to be more effective. Stopping and starting can cause a biologic to lose its effectiveness and may cause certain side effects.

It’s also possible for a biologic to stop working after a person takes it for some time. If this happens, another biologic may work. 

While a biologic can lose its effectiveness over time, studies show that for many people a biologic remains an effective and safe treatment for years.

Not every biologic works for everyone

It is important to know that no one biologic works for everyone. One biologic could fail to help you, but another could work very well.

How to use

This varies with the type of biologic. You’ll either get a shot or an infusion (through an IV). Some shots you can give yourself at home, after learning how to give yourself the shot. Infliximab requires an infusion (through an IV), so you’ll need to go to your doctor’s office or an infusion center for treatment. 

How often you take the biologic varies from twice a week to once every three months. Your dermatologist will tell you how often you should take it.

Tell your dermatologist about current medications

Be sure your dermatologist knows all of the medicines you take, including ones that you can buy without a prescription.

Possible side effects

Each biologic has its own list of possible side effects. Most are mild and do not cause patients to stop taking the biologic. Some of the more common side effects include:

• Upper respiratory tract infection

• Skin reaction where the biologic is injected

• Flu-like symptoms

• Urinary tract infection

• Headache

Because the biologics work by calming down part of your immune system, anyone taking a biologic has an increased risk of developing a serious infection. The risk is higher in patients who have diabetes, smoke or chew tobacco, or have a history of infections. Older patients also have a higher risk. 

Biologics and pregnancy

Pregnant? Breastfeeding? Planning to become pregnant? Be sure your dermatologist knows.

Dermatologists watch their patients for signs of problems. You will need to get some tests while taking a biologic; however, you will need fewer tests than when taking another strong psoriasis medicine like cyclosporine or methotrexate.

What to discuss with your dermatologist

You should tell your dermatologist if you:

• Have any side effects while taking the biologic

• Stop taking the biologic

• Have questions, including how to take the biologic

• Become pregnant

Biologics and vaccines

Before you get a flu shot or vaccinated against any disease, call your dermatologist. You should NOT get some vaccines while taking a biologic.

Related AAD resources

• How long can I take a biologic to treat psoriasis?

• Should you stop treating psoriasis with a biologic during the coronavirus pandemic?

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References
Cordoro KM. “Management of childhood psoriasis.” Adv Dermatol. 2008;24:125-69.

Feldman SR. “Treatment of psoriasis.” UpToDate 2015 Jul, Wolters Kluwer Health. Last accessed November 2015. 

Kim WB, Marinas JEC, et al. “Adverse events resulting in withdrawal of biologic therapy for psoriasis in real-world clinical practice: A Canadian multicenter retrospective study.” J Am Acad Dermatol 2015;73:237-41.

Marks, B. “More than skin deep: Triggers, treatments, and you.” An educational session hosted by the National Psoriasis Foundation. Chicago: Presented June 20, 2015.

Motaparthi K, Stanisic V, et al. “From the Medical Board of the National Psoriasis Foundation: Recommendations for screening for hepatitis B infection prior to initiating antietumor necrosis factor-alfa inhibitors or other immunosuppressive agents in patients with psoriasis.” J Am Acad Dermatol. 2014 Jan;70(1):178-86.

Singh JA, Wells GA, et al. “Adverse effects of biologics: a network meta-analysis and Cochrane overview.” Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD008794. DOI: 10.1002/14651858.CD008794.pub2.