"Biologics" are a class of medications that have become an important treatment option for psoriasis.
Biologics work by targeting the underlying cause of psoriasis - excessive skin cell growth due to an overactive immune system. Although they can often provide long periods of clear skin, biologics are not a cure for psoriasis and ongoing treatment remains necessary.
Biologics are different from traditional medications because they target specific parts of the immune system rather than impacting the entire immune system. For instance, some of the biologics block a type of immune cell called a T-cell, and other block chemical signals, such as Tumor Necrosis Factor-alpha (TNF-alpha), Interleukin 17-A, or Interleukins 12 and 23.
Because biologics are more targeted, they often cause fewer side effects with the liver, kidneys, and other organs that may be caused by other psoriasis medications.
A biologic medication may be prescribed for a person whose psoriasis is:
- moderate to severe
- cannot be controlled effectively with other psoriasis treatments, or
- cannot tolerate the side effects of other psoriasis medications.
Effectiveness
Multiple studies have shown 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.
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.
FDA Approved Biologic Medications for Psoriasis
In the last decade, the U.S. FDA has approved several biologics for the treatment of psoriasisand psoriatic arthritis, including:
- Abatacept (Orencia®)
- Adalimumab (Humira®)
- Brodalumab (Siliq®)
- Certolizumab pegol (Cimzia®)
- Etanercept (Enbrel®)
- Golimumab (Simponi Aria®)
- Golimumab (Simponi®)
- Guselkumab (Tremfya®)
- Infliximab (Remicade®)
- Ixekizumab (Taltz®)
- Risankizumab-rzaa (Skyrizi®)
- Secukinumab (Cosentyx®)
- Spesolimab-sbzo (Spevigo®)
- Tildrakizumab-asmn (Ilumya®)
- Ustekinumab (Stelara®)
How Biologics Are Administered
Biologics are administered with a shot of through an IV infusion (IV). Biologics cannot be taken by mouth (orally) because the stomach acid would destroy the active ingredient.
Some biologics can be self-administered at home after learning how to give yourself the shot. Others, such as Infliximab must be given via an IV so you need to go to the doctor's office or an infusion center to receive treatment.
The frequency of administration depends on the biologic being used. Some are given twice a week while others are given only once every 3 months.
Categories of Biologic Medications
Tumor necrosis factor-alpha (TNF-alpha) blockers
These are drugs that block TNF-alpha. TNF-alpha is a cytokine, or a protein, that prompts the body to create inflammation. In psoriasis and psoriatic arthritis, there is excess production of TNF-alpha in the skin or joints. That leads to the rapid growth of skin cells and/or damage to joint tissue. Blocking TNF-alpha production helps stop the inflammatory cycle of psoriatic disease.
- Cimzia® (certolizumab pegol)
- Enbrel® (etanercept)
- Humira® (adalimumab)
- Remicade® (infliximab)
- Simponi® (golimumab)
- Simponi Aria® (golimumab)
Interleukin 12 and 23 (IL-12/23) Inhibitors
These biologics work by selectively targeting the proteins, or cytokines, interleukin 12 (IL-12) and interleukin 23 (IL-23) that associated with the inflammation of psoriasis
- Stelara® (ustekinumab)
Interleukin 17 (IL-17) Inhibitors
These biologics bind to and inhibits a cytokine, or protein, called interleukin-17A (IL-17A), which is involved in inflammatory and immune responses.By inhibiting cytokines that trigger inflammation, these drugs interrupt the inflammatory cycle of psoriasis. This can lead to improvement in symptoms for many people who take it.
- Bimzelx® (bimekizumab-bkzx)
- Cosentyx® (secukinumab)
- Siliq® (brodalumab)
- Taltz® (ixekizumab)
Interleukin 23 (IL-23) Inhibitors
These biologics work by targeting interleukin 23 (IL-23) to reduce inflammation and low disease progression.
- Ilumya® (tildrakizumab-asmn)
- Skyrizi® (risankizumab-rzaa)
- Tremfya® (guselkumab)
Interleukin 36 (IL-36) Pathway Inhibitors
These biologics work by targeting the chemical pathway of interleukin 36 (IL-36). Interleukin 36 is associated with inflammation in generalized pustular psoriasis.
- Spevigo® (spesolimab-sbzo)
T-Cell Inhibitors
These biologics target the T-cells in the immune system. T-cells are a type of white blood cell that are involved in the inflammation process. These medications prevent T-cells from becoming activated to reduce inflammation.
- Orencia® (abatacept)
Biosimilars
A biosimilar is similar to a biologic treatment that is already approved by the FDA – which is often called the “reference product.”. The active ingredient (chemical name) is the same, but it is marketed under a different brand name. There are no clinically meaningful differences between biosimilars and their reference biologics. The National Psoriasis Foundation Medical Board has issued a statement on biosimilar substitution. Read the statement.
Biologics in Development
There are presently are several biologic medications in development.
Risks of Biologic Medications for Psoriasis
Talk with your doctor about the possible short-term and long-term side effects associated with biologics. Your doctor can help you weigh the risks and benefits of this treatment option.
Common side effects for biologics include:
- respiratory infections
- flu-like symptoms
- redness and swelling at the injection site
Biologics can increase the risk of infection. Individuals who develop any sign of an infection such as a fever, cough or flu-like symptoms or have any cuts or open sores should contact their doctor right away. A biologic medication may not be recommended if your immune system is significantly compromised, or you have an active infection.
Screening for tuberculosis (TB) or other infectious diseases is often required before starting treatment with biologics.
Do not take biologics if:
- Your immune system is significantly compromised;
- You have an active infection.
Biologics and Vaccines
Before you get a flu shot or vaccinated against any disease, call your doctor. You should not get some vaccines while taking a biologic.
Biologics and pregnancy
Speak with your doctor if you are pregnant, planning to become pregnant or breastfeeding
Using Biologic with Other Psoriasis Treatments
All the current biologics can be used with other treatments such as phototherapy or topicals, though using phototherapy along with Remicade may increase skin cancer risk.
Some may be used with oral methotrexate (Cimzia, Enbrel, Humira and Remicad)
Talk with your doctor about using any other psoriasis medications with your biologic, including alternative treatments.
Biologic Use in Children
The FDA has approved the following biologics for children who have moderate or severe psoriasis:
- Enbrel® (etanercept): Approved for people 4 years of age and older
- Stelara® (ustekinumab): Approved for people 12 years of age and older
- Cosentyx® (secukinumab: Approved for people 6 years of age and older
Insurance Coverage and Reimbursement
Biologics prescribed for the treatment of psoriasis are not always covered by health insurance. It is important to check with your health insurance carrier to see if and how biologics are covered. Some insurance companies offer partial coverage, require prior authorization, or work only with certain pharmacies through mail-order programs.
Also, some biologics manufacturers provide information on how to work with insurance companies and offer reduced-cost medication for qualifying patients.
Source: Vivacare
Last updated : 7/3/2024