How Biologics Work for Psoriasis
Biologics have been used in the United States to treat psoriasis for almost two decades; the first was approved by the FDA in 2003. Since then, this drug class has not only grown but also changed the treatment landscape for psoriasis by helping more people find effective solutions and achieve clearer skin.
While this class of medications isn’t necessarily new anymore, they can still feel new to many people who are considering them for the first time. If you’re one of them and have questions, read on to get the answers.
What are you looking to learn about biologics for psoriasis?
Psoriasis: A Disorder of the Immune System
On the surface, psoriasis is a skin disease, but because plaques and other symptoms are caused by inflammation inside the body, the best way to treat moderate to severe psoriasis is often with systemic medications that block the immune system’s inflammatory response.
Why does your body create this inflammation? It’s part of your immune system’s natural defense against foreign invaders that might make you sick. But with psoriasis, your immune system is overactive, and causes excess inflammation, which activates skin cells to multiply too fast, leading to plaques on your skin.
In other words, psoriasis is an autoimmune condition where your immune system gets “angry” at your skin, says Joshua Zeichner, MD, director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York.
How Biologics Treat Psoriasis From the Inside Out
Biologic medications are created using living cells that are similar to molecules in your immune system and work within the body to target inflammation and psoriasis plaques at the source.
Biologics differ from other common psoriasis treatments for two reasons:
- Rather than treating existing plaques (as topical therapies do), biologics get to the root of psoriasis by blocking the inflammatory process in your body before it even starts.
- Unlike traditional systemic therapies, which broadly suppress the immune system, biologics target specific molecules linked to psoriasis.
8 Essential Facts About Biologics for Psoriasis
1. There are 11 biologic medications for psoriasis.
Each of the 11 biologics available for treating psoriasis target different pathways thought to cause it, which is why you may need to try multiple types of biologics before finding the right match that helps control your psoriasis.
- ustekinumab (Stelara®)
- brodalumab (Siliq™)
- ixekizumab (Taltz®)
- secukinumab (Cosentyx®)
- guselkumab (Tremfya®)
- risankizumab (Skyrizi™)
- tildrakizumab (Ilumya™)
- adalimumab (Humira®)
- certolizumab pegol (Cimzia®)
- etanercept (Enbrel®)
- golimumab (Simponi Aria®)
- infliximab (Remicade®)
- abatacept (Orencia®)
2. Biologics are usually prescribed to treat moderate to severe psoriasis.
Before prescribing any psoriasis treatment, your doctor may identify the severity of your condition in one of three categories, depending on how much of your body is covered in skin lesions:
- Mild: covers less than 3 percent of your body
- Moderate: covers 3 to 10 percent of your body
- Severe: covers greater than 10 percent of your body
Even if psoriasis covers only a small part of your body, it could still be considered severe if it greatly impacts your quality of life.
3. Biologics are administered by infusion or injection.
Different biologics are taken different ways, but they all involve a needle. Some biologics are given by intravenous (IV) infusion in a clinic setting, while others are done at home, using an auto-injector to give yourself a shot under the skin.
4. Most people have clearer skin within 3 to 4 months.
You may notice some decrease in psoriasis symptoms as soon as one week after starting the medication, but most of the benefits will be seen around 12 weeks. Symptoms may continue to improve for months afterward.
5. Biologics may help prevent related health conditions.
“While psoriasis plaques affect the skin, we know that psoriasis is a systemic inflammatory condition,” says Dr. Zeichner. “It’s associated with arthritis — a condition called psoriatic arthritis — so if you have joint aches, it is important to treat them early.” Left untreated, joint damage from psoriatic arthritis is permanent and progressive.
People who have psoriasis are also at higher risk for cardiovascular disease, diabetes, and Crohn’s disease.
According to the National Psoriasis Foundation, reducing inflammation in the skin also reduces inflammation in the rest of the body, which in turn can help reduce the likelihood of developing these related health risks.
6. Over time, a biologic’s effectiveness might diminish.
After months or years of taking a certain biologic, it may become less effective for you. That’s because your immune system may develop antibodies to the drug, particularly if you missed any doses. If this happens, you might notice plaques gradually coming back, and your doctor may recommend switching to another biologic.
7. They’re considered safe but do have potential side effects.
The most common side effects of biologics are pain and skin reactions at the site of the injection. It’s also possible to have an allergic reaction that leads to a rash, itchiness, shortness of breath, or dizziness.
Since biologics work by suppressing your immune system, they increase your susceptibility to infections, such as bacterial and fungal infections, and may increase your risk of tuberculosis (TB) and lymphoma. Before starting a biologic, your doctor will run tests to make sure the drug is safe for you to take.
8. Biologics are expensive, but you likely won’t pay all of it out of pocket.
Biologics can cost between $10,000 and $30,000 per year, and potentially up to $500,000 for the most expensive options. Most insurance companies cover at least a portion of that, but how much you’ll pay out of pocket and which drugs are covered depends on your insurance plan.
If you cannot afford the biologic you’re prescribed, talk to your doctor or pharmacist about your options. Your state may have a drug plan to assist with medication costs. You can also check the drug manufacturer’s website for their patient assistance program (PAP): You might qualify for lower co-pays or even be able to get the medication free.
Is It Time to Try a Biologic to Treat Psoriasis Symptoms?
If you’re struggling to get your psoriasis symptoms under control, there is good news: Today, there are more psoriasis therapies than ever before, and a dermatologist can help you find the right treatment — or combination of treatments — that meets your particular needs.
Before trying biologics, your doctor may suggest trying the following treatments.
- Topicals: Topicals include topical corticosteroids, vitamin D analogues, anthralin, topical retinoids (vitamin A derivatives), salicylic acid, coal tar, and moisturizers. These creams and ointments are applied to the affected skin, so they only work on the surface to treat the outward symptoms of psoriasis and do not impact inflammation within the body.
- Phototherapy (light therapy): Light therapy uses natural or artificial ultraviolet light to slow skin cell growth and reduce inflammation. Phototherapy includes natural sunlight or artificial ultraviolet A (UVA) or ultraviolet B (UVB) light.
- Traditional systemics: Medications such as methotrexate and cyclosporine suppress the immune system on a broad level to reduce inflammation and prevent psoriasis symptoms and progression. They can be used alone or in combination with a biologic to treat psoriasis.
Treatment depends on your preferences and how severe the psoriasis is, Zeichner says. “In mild cases, topical creams may do the trick,” he says, “but if larger body surfaces are involved, then systemic medications such as biologics may be necessary.”
A Psoriasis Expert Answers Common Questions About Biologics
Do you still have questions about biologics? We talked to Anna Guanche, MD, a board-certified dermatologist and founder of Bella Skin Institute, about the most common questions she hears from patients and got answers.
Quiz: How Much Have You Learned?
Test Your Knowledge of Psoriasis Treatment
Next Steps: Making Psoriasis Treatment Decisions
You’ve learned a lot about biologics. Take some time to think about your own psoriasis care and what you might want to discuss with your doctor.
Before your next appointment, reflect on these questions your doctor might ask you about your current treatment plan.
- Are you satisfied with your current psoriasis treatment?
- Has it improved your skin and overall health as well as you had hoped?
- Does psoriasis impact your emotional health and quality of life?
- Are you downplaying your symptoms when speaking to your doctor?
- Are you following your psoriasis treatment regimen as prescribed?
- Have you tried other treatment options?
If you decide it’s time to discuss a potential treatment change with your doctor, jot down some questions you’d like to ask. Here are a few conversation starters you can save to your phone and bring to your next appointment.
- What can I do to improve my skin?
- Am I a good candidate for biologics?
- Which medication are you prescribing for me and why?
- What results do you expect?
- How long should I use this medication before I notice any progress?