Some people who have psoriasis also experience psoriatic arthritis, a chronic and inflammatory form of arthritis that impacts major joints, like knees and hips.

Symptoms of psoriatic arthritis generally include joint pain, swelling, and redness. New guidelines suggest that people who have psoriatic arthritis should turn to biologics first. Still, many questions surround exactly what biologics are, how they can help manage the condition, and how biosimilars may be used instead of biologics.

In the past, psoriatic arthritis was typically managed through injectable and oral prescription drugs. These included anti-inflammatory or immunosuppressive medications.

Oftentimes, these medications were paired with self-care methods like icing and heating.

Anti-inflammatory or immunosuppressive drugs, while helpful for some people with psoriatic arthritis, can cause uncomfortable side effects for others. Possible side effects can include:

  • stomach irritation
  • heart problems
  • liver and kidney damage

Since biologics are more effective, these drugs are now being used to treat moderate to severe psoriatic arthritis. Previously, biologics were only considered when other treatments didn’t work. Biologics have been shown to be more effective than traditional drugs, but they are more expensive too.

Biologics can also be tough to differentiate from biosimilars, a similar version of the originally approved drug.

Here are answers to frequently asked questions about biologics and biosimilars when it comes to psoriatic arthritis management:

The names may sound similar, but biologics and biosimilars aren’t exactly the same thing.

Unlike traditional systemic drugs, biologics target specific areas of the immune system. These drugs are made from living organisms like animals, yeast, and bacteria.

For psoriatic arthritis in particular, biologics can block proteins made by activated immune cells. These inflammatory cytokines cause the disease symptoms and lead to disease progression.

Biologic drugs are typically given by injection or IV infusion. Because biologics are proteins, stomach enzymes would inactivate them.

Biosimilars are a type of biologic drug modeled after the original Food and Drug Administration (FDA)-approved biologic medication. These drugs have a different approval process. Biosimilars can move through the development and approval process more quickly.

While slightly different from one another, the FDA approval process shows that biosimilars are just as safe and effective as the biologic products they’re modeled after.

Biosimilars aren’t necessarily better than biologics, but there may be some advantages to them.

Biosimilars are the same strength and dosage as biologics. They also have the same amino acid sequences, which means both medications work the same way.

However, biosimilars cost less than biologics, as do most generic drugs. The Arthritis Foundation estimates that biologics can cost some people thousands of dollars each month. Biosimilars, therefore, may be more attractive than biologics because of their cost-savings.

Unlike a generic medication, which is a copy of a chemical drug, biosimilars are modeled after biologics, meaning there can be slight differences between the two. Some people with psoriatic arthritis worry that pharmacists may substitute a biosimilar for a biologic without saying so. Doctors also express some concerns over this.

Many states are passing or considering laws about pharmacy substitutions, so there may not be a reason to worry, depending on where you live.

Biosimilars are just as safe as biologics. Both undergo thorough testing before being granted FDA approval, making biosimilars and biologics equally safe treatment options for psoriatic arthritis.

The National Psoriasis Foundation suggests possible side effects between biologics and biosimilars are the same as well. These can include:

  • abdominal pain
  • flu-like symptoms
  • headache
  • injection site reactions
  • upper respiratory infections

Biosimilars tend to be less expensive than biologics because the original drug development has already occurred, and marketing and production costs are often lower.

Unlike biologics, biosimilars aren’t branded products. This means that they don’t have a name attached to them from the original patent approval that can make them run on the more expensive side.

It can also cost less to produce biosimilars than biologics. Biosimilars require much less research, development, and testing, as the biologic itself already exists. Some online retailers like GoodRx may offer discount coupons for non-branded products like biosimilars, which can help lower the cost as well.

Biologic medications are expensive because they’re made from living organisms. These types of drugs cost significantly more to produce than drugs made from chemicals.

Though some biologics can be administered at home through self-injection, others require an IV infusion, which increases the costs further.

Since biologic medications are designed to target specific areas of the immune system, they undergo more thorough research, development, and testing. This plays a role in price.

A 2018 report suggests biologics and biosimilars can cost on average $10,000–$30,000 per year, sometimes going above $500,000 for the most expensive biologics on the market. The report also argues that availability plays a big role in driving costs up, rather than down.

Your insurance can impact any out-of-pocket costs as well. This means the price can vary depending on the type of plan and coverage you have.

Biologics and biosimilars are both FDA-approved drugs used to treat and manage psoriatic arthritis. They share many similarities, but biosimilars aren’t branded and tend to be cheaper.

Your doctor can help you decide if one of these medications might be accessible and a good option for you.