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.
Switching to a biologic agent for psoriasis might be the next step. Here are five reasons why you should consider switching to a biologic, 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. But these treatments often don’t work well enough for those with moderate to severe cases. Some treatments may also lose effectiveness over time.
If you have moderate to severe psoriasis and your current treatment regimen isn’t working, it’s time to start considering a biologic. 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 you can’t tolerate those treatments because of side effects.
Though biologics are typically reserved for those with moderate to severe psoriasis, 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 the feet, palms, face, or genitals. The pain may prevent you from doing normal 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) only need to be injected once every 12 weeks after the first two initial 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 can still cause side effects, but they tend to be less severe. The most common side effects are minor irritation, redness, pain, or a reaction at the site of injection. There’s also a slightly higher risk of serious infections.
Another possibility is to take a combination of your current therapy along with a biologic. By combining treatments, you can improve the efficacy of your treatment and lower the dose. This helps to decrease side effects. 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.
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 their safety and effectiveness.
You may be hesitant to talk to your doctor about biologics because you heard they were “stronger” drugs. Or perhaps you’re worried they’re too expensive. While it’s true that biologics are considered a more aggressive treatment option and have a high price point, they’re more targeted drugs, which means they work very well. They also may 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 can’t get over your fear of needles in order to take a biologic, 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.
There are now 11 biologics on the market to treat psoriasis:
- infliximab (Remicade)
- adalimumab (Humira)
- etanercept (Enbrel)
- ustekinumab (Stelara)
- ixekizumab (Taltz)
- secukinumab (Cosentyx)
- guselkumab (Tremfya)
- brodalumab (Siliq)
- certolizumab pegol (Cimzia)
- tildrakizumab (Ilumya)
- risankizumab (Skyrizi)
You will have to work with your insurance company to find out which biologics are covered under your plan. Your doctor can help you decide which may work best for your particular situation.
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.