Psoriasis treatment isn’t a one-size-fits-all approach. If your goal is total clearance of your psoriasis, you’ll probably have to try out many different treatments before finding one that works best for you. One option: biologic drugs.
Biologics are medications that target specific proteins within the immune system to slow down disease activity at the source. They’re administered in one of two ways: via intravenous infusion at a clinic or via an auto-injector you can use yourself at home.
There are currently 13 biologics on the market to treat psoriasis:
- abatacept (Orencia)
- adalimumab (Humira)
- brodalumab (Siliq)
- certolizumab pegol (Cimzia)
- etanercept (Enbrel)
- golimumab (Simponi and Simponi Aria)
- guselkumab (Tremfya)
- infliximab (Remicade)
- ixekizumab (Taltz)
- risankizumab (Skyrizi)
- secukinumab (Cosentyx)
- tildrakizumab (Ilumya)
- ustekinumab (Stelara)
Your doctor can help you decide which may work best for your particular situation. It may take some trial and error to find the right biologic for you.
Here’s how to know whether switching to a biologic agent for psoriasis might be a good next step for you, along with some advice on how to overcome any hesitation you may have about making the switch.
Traditional treatment options for psoriasis include topical creams, corticosteroids, cyclosporine, retinoids, methotrexate, and phototherapy. People with mild to moderate psoriasis can usually manage their disease well with topical treatments.
However, these traditional treatment options may lose effectiveness over time, and they often don’t work well enough for those with moderate to severe cases.
The American Academy of Dermatology suggests taking a biologic agent if you have moderate to severe psoriasis that hasn’t improved using more traditional systemic agents or if you can’t tolerate those treatments because of side effects.
Biologics are typically reserved for those with moderate to severe psoriasis, but they could be an option if your psoriasis is greatly affecting your quality of life.
Even if your psoriasis is considered mild, you may have painful plaques on the soles of your feet, your palms, your face, or your genitals. The pain may prevent you from doing your usual activities. In these cases, a switch to a biologic may be justified.
Many psoriasis treatments have to be taken daily to be effective. It can be hard to remember to take your medication on time, especially if you’re busy or you travel often. Biologics, on the other hand, are usually taken less frequently.
Some biologics have to be injected once per week, but others, like ustekinumab (Stelara), need to be injected only once every 12 weeks after the first 2 doses.
You can also give yourself most biologics at home after being trained by a medical professional.
Psoriasis treatments like cyclosporine, corticosteroids, and methotrexate are known to cause side effects like mouth sores, nausea, upset stomach, and even skin cancer.
Biologics work in a more selective way than other psoriasis treatments. They target specific proteins in the immune system that have been proven to be associated with psoriasis. For this reason, they have fewer side effects than less-targeted treatments.
Biologics still come with side effects, but they tend to be less severe. The most common side effects are minor irritation, redness, pain, or a reaction at the injection site. There’s also a slightly higher risk of serious infections while taking a biologic drug.
You can also add a biologic to your existing psoriasis treatment plan. Combining treatments can improve the efficacy of your regimen, often at a lower dose. This helps decrease side effects.
Options including certolizumab pegol (Cimzia), etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade) have been shown to be safe and effective when taken with methotrexate.
Biologics are expensive. Most cost more than $20,000 per year. Not all insurance plans will cover enough of the costs.
If you’ve recently changed insurance, check how the new insurance company covers biologics. Your out-of-pocket expenses may have gone down considerably with the new insurance company, making it easier for you to afford biologic therapy. If so, work with your doctor to determine whether you should make the switch.
Biologics aren’t new. The first biologic for psoriasis was approved in 2003. Over the last couple decades, researchers have gathered quite a bit of evidence to support the safety and effectiveness of these medications.
You may be hesitant to talk with your doctor about biologics because you’ve heard they’re “stronger” drugs. Or perhaps you’re worried they’re too expensive.
It’s true that biologics are considered a more aggressive treatment option. They also have a high price point. But they’re more targeted drugs, which means they work very well. And they tend to have fewer side effects than other psoriasis treatments.
Still, you shouldn’t take a biologic if:
- your immune system is significantly compromised
- you have an active infection
- you recently received a live vaccine such as shingles, MMR (measles, mumps, and rubella), or flu mist
- you’re pregnant or nursing (though biologics can still be prescribed if there is a clear medical need)
If you’re afraid of needles, ask your doctor about a new treatment for psoriasis known as apremilast (Otezla). Otezla is taken as a pill twice per day. It isn’t considered a biologic. Rather, it’s in a new class of drugs known as PDE4 inhibitors. Otezla is FDA-approved to treat moderate to severe plaque psoriasis when phototherapy or systemic therapy is appropriate.
Biologics have been around for decades, and research continues to expand. It’s likely that even more treatment options will be available in the near future.
Switching psoriasis treatments is a common and accepted practice. Now could be a good time to start thinking about biologic therapy. Of course, the decision to start biologic treatment for psoriasis should be made alongside your doctor.