Biologics offer effective relief from psoriasis, but they may not be right for everyone. Before starting one, you may want to ask your doctor some questions to help you better understand your options.

Biologics are a newer form of medication that provide targeted treatment for psoriasis and other chronic conditions.

Manufacturers make biologics using living organisms, tissue, and other components. This makes the process of production more time-consuming and expensive compared to medications that use synthetic materials.

Biologics often offer effective relief from psoriasis symptoms, but they can also cause side effects and may not work as well for everyone.

If a doctor recommends that you try a biologic, here are some questions to help get you started.

If a doctor recommends taking biologics for your psoriasis, they probably have a good reason. Asking them for an explanation helps you better understand your treatment and make decisions related to your health.

Strong evidence suggests that biologics help to improve moderate-to-severe psoriasis, often after several weeks of use.

A 2020 literature review noted that some studies showed that some newer biologics, such as risankizumab, helped improve plaque psoriasis Psoriasis Area Severity Index (PASI) scores as follows:

  • Week 16: 70–80% improvement
  • Week 52: 80–90% improvement
  • Week 52: 50–60% of all people receiving treatment saw full remission of symptoms

Their findings reflect earlier studies that noted that people often see 75–90% reduction in skin lesions.

A doctor may recommend biologics if you do not respond well to other treatments, such as other medications or topicals.

A doctor may recommend some testing before you start taking biologics. This is not to check whether you’ll respond well to treatment. Instead, a doctor may check for the presence of other medical conditions, such as tuberculosis, that may worsen if you start taking biologics.

Biologics suppress part of your immune system. While this helps to clear up plaques and lesions and suppress the condition, it can also make you more susceptible to infections.

To help reduce the risk of serious infections, doctors may:

  • prescreen before beginning biologics
  • provide resources on checking for infections
  • temporarily discontinue biologic treatment at first signs of an infection
  • provide guidance on when to seek emergency services

The Food and Drug Administration (FDA) has approved 11 different biologics for the treatment of psoriatic disease with additional options potentially getting approval in the future.

Different biologics work in slightly different ways and target different pathways within your body that may cause psoriasis.

In some cases, you may start a biologic and find no changes after several weeks of use. If this occurs, a doctor may recommend a different biologic that may work better.

When picking a biologic for you, a doctor will likely take into account several factors, including:

  • your current health
  • previous treatments
  • the presence of comorbid conditions, such as pregnancy, infections, or other chronic conditions
  • your preferences in treatment

Keep in mind that your preferences are important, too. If you don’t like the idea of infusions or injections, then biologics may not be the best choice for you.

Biologics can cause adverse reactions or side effects. It is a good idea to speak with your doctor before starting a treatment with biologics about what you might expect from the therapy.

What side effects do they see most often? Who is at higher risk? What is the plan if side effects occur?

Two common concerns with biologics include hepatitis B reactivation and pneumonia.

You’ll likely want to review your medical history with any prescribing doctor to see if they have any concerns about the potential for infection. You may also need to stop taking biologics for a short period of time if you do develop an infection.

It’s important to discuss the chances of becoming pregnant or plans to become pregnant with the prescribing doctor. They may have specific recommendations based on your plans surrounding childbirth.

Another consideration before starting biologics is the cost. Biologics cost companies more to manufacture than other medications, such as small molecule drugs, which use synthetic compounds.

Some insurance companies may not cover the cost of biologics.

A doctor or other healthcare professional may write to your insurance company to explain the medical necessity, which may help get the therapy approved.

According to an older study from 2016, regulation of insurance coverage for biologics increased from 2009 to 2014. The researchers noted that the time from insurance claim submission to decision took more days, and the denial of claims went from 0% in 2009 to 19% in 2014.

The main reason for denial in the study involved not trying other therapies first.

A 2019 study found that people who either discontinued or switched biologics had a higher cost of care and utilized more healthcare compared with those who remained on the same biologic.

Discussing costs and insurance coverage with a doctor first may help prevent surprise or large, unexpected bills from denied insurance claims.

Whether you are hesitant to start or want to try other treatments, it may be helpful to ask a doctor what they believe your other treatment choices may be.

Chances are good that, if they’re recommending biologics, you have tried several different treatments before without success. However, they may still have recommendations or options they can consider, which may include similar treatments to what you’re already using.

You may also find it helpful to seek a second opinion. Another doctor may have additional treatment suggestions that might appeal to you more.