Biologic Medications for Psoriasis - Health Tips

I like to discuss the various types of ever growing biologics and include anti-TNF (Enbrel, Humira, Remicade, Cimzia, biosimilars), IL17 (Taltz, Cosentyx and the new ones becoming available), IL12/23 (Stelara), IL 23 (Tremfya, Skyrizi, Illumya) including new ones that will become available and Otezla (oral) not really a biologic, but it is included...as are the Jak inhibitors, both experimental and Xeljanz and Rinvoque for PSA. I describe the possible side effects, but I consider these treatments the best way to go for moderate to severe psoriasis and psoriatic arthritis. I encourage my patients to choose an appropriate biologic and one that fits into their lifestyle as well. This is a partnership between my patients and myself. I stress the safety of biologics even in the time of COVID. 

Biologics are fabulously effective at treating psoriasis. They are very safe too. Biologics may be a very good choice for people who have extensive psoriasis. Patients may be candidates for biologic treatment when the psoriasis is too extensive to treat with topicals or when there is a debilitating disease that is resistant to other treatments (like palm and sole psoriasis).

Biologics are costly. Insurers may have specific policies regarding when they will pay for particular biologics. Pharmaceutical companies that make biologics often have programs that help patients get access to the treatment.

If you have moderate to severe psoriasis or psoriatic arthritis, you've probably considered a biologic treatment. Dr. Paul Yamauchi, Medical director of Dermatology Institute and Skin Care Center of Santa Monica, provides an informative discussion of biologic treatments.

Whether you are considering starting on a biologic, have been receiving one for a long time, or are interested in the next generation treatments coming down the pipeline, this webcast presentation will be one to watch.

Stelara® is useful for patients that have tried other biologics and failed.

It also requires less injections and may be better for people who cannot treat themselves since they are given in the physician's office.

Visit Dr. Pace's webste at Pace Dermatology Associates

Biologics are the most recent advances in the treatment of psoriasis, though they have been in use in the U.S. for nearly 14 years. Biologics were initially considered 2nd line agents, but can now be considered 1st line therapy for severe, diffuse or resistant cases of psoriasis.

These drugs include such tongue-twisting names as infliximab, etanercept, adalimumab, and ustekinumab.

Biologics are often easy to use and offer dosing regimens that range from twice a week to once every 3 months. They also appear to be very safe, with minimal lab monitoring, and low side-effect profile.

Biologics should be considered when someone has psoriasis that is limiting their daily life in terms of function or psychosocially. Some examples of this include the following:

• When psoriasis covers large areas of the body so that applying a topical medication to all of the affected areas is impractical. In such cases, using a "whole body" therapy, such as biologics, might be considered.
• When psoriasis is especially severe, even if the affected area is limited. Examples include severe/resistant hand psoriasis in a surgeon or pianist, facial psoriasis in an actress or newscaster, or foot psoriasis in an athlete.

Psoriasis that requires "whole body" therapy, but has failed other, non-biologic treatments, such as UV phototherapy, methotrexate, and acitretin to name a few.

Each case of psoriasis has unique characteristics and each individual has a unique health history and lifestyle. These variables may make one medication a better fit for a particular patient than another.

In general, make sure you consult with a board-certified dermatologist who is experienced with treatment of complicated psoriasis.

In general, I tend to prescribe etanercept (Enbrel®) and adalimumab (Humira®) as my first agents -- both have a long track record of safety with excellent effectiveness, and are quite similar in their mode of action.

Ustekinumab (Stelara®) is the newer kid on the block, and for this reason, I generally reserve it if someones fails or does not respond sufficiently to my first options. Because Stelara® works by a different mechanism of action, there are some patients in which it may be my first line agent. Infliximab (Remicade®), while probably the most potent, also has a higher side-effect profile and requires an IV infusion, so I reserve this for my most resistant patients.