Researchers now know a lot more about psoriasis and the role the immune system plays in the disease. These new discoveries have led to safer, more targeted, and more effective treatments for psoriasis.
Despite all of the available therapies for psoriasis, over 50 percent of those being treated for the condition say they’re dissatisfied with their treatment.
If you’re looking to change treatments because your current treatment is no longer effective or you’re having side effects, it’s a good idea to learn as much as possible about the latest options.
New oral treatments
Apremilast (Otezla) is a pill that you can take by mouth. It was approved by the U.S. Food and Drug Administration (FDA) in 2014.
Unlike earlier oral treatments used for psoriasis, apremilast is more selective. It targets an enzyme inside immune cells known as phosphodiesterase 4 (PDE4). By inhibiting this enzyme, it helps control the overactive immune response that triggers inflammation in people with psoriasis.
Apremilast is taken twice per day. The more common side effects include diarrhea, nausea, headache, and upper respiratory infection.
Apremilast can be taken alone or with other psoriasis treatments like phototherapy, topical medications, and methotrexate.
Biologics are medications made from substances found in living things, like proteins and antibodies. Once in the body, biologics block a part of the immune system that contributes to your psoriasis symptoms.
Biologics may interfere with TNF-alpha, T cells, or interleukins. This in turn helps ease inflammation.
Brodalumab (Siliq) was approved by the FDA in 2017. It’s for people with moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy and don’t respond to other systemic therapies.
Brodalumab is administered as an injection. It works by binding to the interleukin-17 (IL-17) receptor. The IL-7 pathway plays a role in inflammation. In clinical trials, more participants treated with brodalumab had skin that was considered clear or nearly clear compared to those who received a placebo.
Like other biologics, brodalumab increases your risk of getting an infection. The label for this drug also has a black box warning about a higher risk of suicidal thoughts and behavior. People with a history of suicidal behavior or depression should be monitored when taking brodalumab.
A new biologic known as guselkumab (Tremfya) was approved by the FDA in 2017. Guselkumab treats moderate to severe plaque psoriasis in people who are also candidates for phototherapy or systemic therapy.
Guselkumab is currently the only biologic that targets interleukin-23 (IL-23). IL-23 is one of the cytokines involved in psoriasis.
After the first two starter doses, guselkumab is given as a subcutaneous (under the skin) injection every eight weeks.
The more common side effects include headache, upper respiratory infections, injection site reactions, joint pain, diarrhea, and stomach flu.
Secukinumab is an antibody that targets interleukin-17 (IL-17). It was approved by the FDA in 2015.
Secukinumab has been shown to deliver high and long-lasting skin clearance in people with psoriasis. In one study, about 44 percent of participants receiving secukinumab had completely clear skin after the first year. After five years, nearly 41 percent had completely clear skin.
To take secukinumab, you’re given two shots at weeks 0, 1, 2, 3, and 4, followed by two shots once a month after that.
Like the other biologics, people taking secukinumab have a greater risk of getting an infection. The more common side effects of secukinumab include diarrhea and upper respiratory infections.
Ixekizumab (Taltz) was approved by the FDA in 2016 to treat adults with moderate to severe psoriasis. It’s meant for people who are candidates for phototherapy, systemic therapy, or both. Ixekizumab targets a protein called interleukin-17A (IL-17A).
The approval was based on the results of multiple clinical studies with a total of 3,866 participants. In those studies, most people taking ixekizumab achieved skin that was clear or almost clear.
The more common side effects of ixekizumab include upper respiratory infections, injection site reactions, and fungal infections.
Biosimilars are the generic drug equivalent for biologics. However, biosimilars aren’t exact replicas of biologics. Instead, they’re reverse-engineered to produce similar results to biologics.
Like generic drugs, biosimilars are made once the original biologic goes off patent. The advantage of biosimilars is that they often cost a lot less than the original product.
Approved biosimilars include:
- Cyltezo and Amjevita, biosimilars to adalimumab (Humira)
- Erelzi, a biosimilar to etanercept (Enbrel)
- Inflectra, Renflexis, and Ixifi, biosimilars to infliximab (Remicade)
Treatments nearing approval
Tildrakizumab is a biosimilar that isn’t yet approved in the United States, but may be very shortly. In 2017, the FDA accepted for review an application for this biosimilar to treat moderate to severe psoriasis. The drug works by inhibiting interleukin-23p19. It has shown promising results in two pivotal clinical trials that included over 1,800 people with psoriasis.
Staying informed about the newest options for treating psoriasis is crucial to managing your condition. There isn’t a one-size-fits-all therapy for psoriasis. It’s likely you’ll have to try out many different treatments before you find one that works best for you and doesn’t cause side effects.
New discoveries in psoriasis happen all the time. Make sure to talk to your doctor about new treatment options.