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Biologics for Psoriasis: What Can They Do for You

Discover the game-changers in psoriasis treatment – Biologics. These innovative medications target the root causes of psoriasis, offering hope for those seeking effective relief.

Let’s explore what biologics can do for you.

Biologics in the Treatment of Psoriasis

biologics for psoriasis

Biologics represent a distinctive class of medications designed for the treatment of psoriasis, setting them apart from conventional systemic drugs that affect the entire immune system. Unlike traditional therapies, biologics pinpoint specific components of the immune system.

Biologics operate by inhibiting the bodily processes responsible for psoriasis and its associated symptoms. These medications selectively target immune system elements involved in psoriasis, such as T-cells, tumor necrosis factor-alpha (TNF-alpha), interleukin 17-A, and interleukins 12 and 23.

Notable biologics used in psoriasis treatment include Enbrel, Humira, and Remicade, all of which are classified as disease-modifying antirheumatic drugs (DMARDs). This designation indicates their intent to slow or halt the processes in the body that lead to joint damage.

Key points to remember regarding biologics in psoriasis treatment are as follows:

  1. Biologics are a more recent and potent class of drugs that exclusively target the hyperactive immune system component responsible for psoriasis.

  2. Typically, biologics are prescribed for individuals with moderate to severe psoriasis.

  3. They are a crucial treatment option for those suffering from moderate-to-severe psoriasis, psoriatic arthritis, or both.

  4. Biologics carry a lower risk of adversely affecting vital organs like the liver and kidneys, compared to other potent psoriasis medications.

  5. While highly effective at relieving psoriasis symptoms, biologics tend to be more costly.

  6. It’s important to note that biologics may increase the risk of infections, making them a less desirable option for certain patients.

  7. Biologics are typically considered when other treatment options have failed to provide sufficient relief.

The following biologics have received approval from the US Food and Drug Administration (FDA) for the treatment of psoriasis or psoriatic arthritis in adults:

  • Brodalumab (Siliq)
  • Certolizumab pegol (Cimzia)
  • Etanercept (Enbrel)
  • Guselkumab (Tremfya)
  • Infliximab (Remicade)
  • Ixekizumab (Taltz)
  • Risankizumab-rzaa (Skyrizi)
  • Secukinumab (Cosentyx)
  • Tildrakizumab (Ilumya)
  • Ustekinumab (Stelara)

Prior to prescribing any psoriasis treatment, your doctor will assess the severity of your condition, categorizing it as mild, moderate, or severe, depending on the extent of skin lesions. Biologics are commonly recommended for individuals with moderate to severe psoriasis.

What is the success rate of biologics for psoriasis

In various studies conducted, the rates of patient persistence with biotechnology therapy after one year ranged from 22% to 85%.

In the Italian observational study OSCAR, the data revealed that, at the 29-month mark of treatment, 81% of patients continued their therapy with etanercept, 59% with adalimumab, and 62% with infliximab.

Which biologic is best for psoriasis

The path to effective psoriasis management involves understanding how different biologic drugs target the immune system proteins known as cytokines. Cytokines are the culprits behind the inflammation and scaly skin patches in psoriasis, and each group of biologic drugs addresses a distinct cytokine.

While individual responses to these medications can vary, research indicates that some biologics exhibit better results in managing psoriasis. In one comprehensive review, it was found that drugs inhibiting two specific proteins, interleukin-17 and interleukin-23, often produced superior skin clearance compared to those targeting TNF-alpha.

Interleukin-17 inhibitors:

  • Brodalumab (Siliq)
  • Ixekizumab (Taltz)
  • Secukinumab (Cosentyx)

Interleukin-23 inhibitors:

  • Guselkumab (Tremfya)
  • Risankizumab-rzaa (Skyrizi)
  • Tildrakizumab (Ilumya)
  • Ustekinumab (Stelara) (Also effective against interleukin-12)

Tumor necrosis factor-alpha (TNF-alpha) inhibitors:

  • Adalimumab (Humira)
  • Adalimumab-atto (Amjevita)
  • Certolizumab pegol (Cimzia)
  • Etanercept (Enbrel)
  • Etanercept-szzs (Erlezi)
  • Infliximab (Remicade)

Your healthcare provider will help you choose the most suitable biologic based on factors such as the degree of skin clearance you desire, any concurrent medical conditions, and your preference for injections or intravenous administration. Medications like ustekinumab (Stelara) and secukinumab (Cosentyx) are often recommended due to their balanced effectiveness and safety profile.

In the event that your initial choice does not effectively manage your symptoms, your doctor can guide you through transitioning to a different type of biologic treatment.

Disadvantages of biologics in psoriasis

While biologics have proven to be effective in treating psoriasis, there are several disadvantages associated with their use:

  1. Cost: Biologics are often expensive, which can be a significant barrier to access for some patients, especially if insurance coverage is limited.

  2. Infections: Biologics can increase the risk of infections because they suppress parts of the immune system. Patients on biologics may be more susceptible to various infections, and it’s crucial to monitor for any signs of illness.

  3. Administration: Biologics are typically administered through injections or intravenous infusions, which may be uncomfortable or inconvenient for some individuals. This can lead to issues with adherence to the treatment plan.

  4. Side Effects: Like all medications, biologics can have side effects, including injection site reactions, headache, fatigue, and in some cases, more serious side effects such as liver problems or heart issues.

  5. Individual Responses: Biologics can have varying degrees of effectiveness from one person to another. What works well for one patient may not work as effectively for another, requiring adjustments or changes in treatment.

  6. Long-Term Safety: The long-term safety of biologics is still being studied, and potential risks may emerge as more people use these drugs over extended periods.

  7. Alternative Treatments: Some individuals may prefer non-biologic treatment options due to concerns about the disadvantages listed above or for other personal reasons.

It’s important for patients to discuss these disadvantages and the potential benefits of biologics with their healthcare providers to make informed treatment decisions tailored to their specific circumstances.

Does health insurance cover biologics

While biologics are often covered by insurance plans, the less favorable aspect is the potential requirement to navigate a complex process for coverage.

Many insurance providers demand prior approval, known as “prior authorization,” before they will extend coverage for a biologic medication.

Who shouldn’t take biologics

Biologics can potentially trigger the reactivation of dormant chronic diseases, such as tuberculosis.

They may not be advisable if you have underlying conditions like multiple sclerosis or severe congestive heart failure.

Before commencing biologic treatment, your healthcare provider will conduct either a skin or blood test to screen for tuberculosis.

What foods should you avoid on biologics

Avoid consuming the following food items for safety reasons:

  1. Unpasteurized Milk and Dairy Products: This includes cheese produced from unpasteurized milk. Examples are mold-ripened soft cheeses like Brie and Camembert, and blue cheeses, regardless of whether they are pasteurized or not. Additionally, feta and goat cheeses fall into this category.

  2. Raw Eggs: Be cautious with foods containing raw eggs, such as homemade mayonnaise.

  3. Raw or Undercooked Meat and Fish: Exercise caution with raw or undercooked meat and fish to reduce the risk of foodborne illnesses.

Can biologics cause weight gain

Our research revealed that the utilization of biologic agents emerged as a substantial and independent risk factor for weight gain.

This finding held true even after accounting for variables such as age, gender, initial weight, total prescription duration, the time lapse between weight measurements before and after psoriasis treatment, physical activity, smoking, alcohol consumption, and the presence of comorbid conditions.

Why are biologics for psoriasis so controversial

Controversy arises due to the practice of certain original biologic companies offering to align their prices with those of biosimilars, enabling patients to stay on the reference product.

However, some government and private drug plans are declining this option, even though it could result in equivalent or even greater cost savings.

Do you have to take biologics for psoriasis forever

For individuals dealing with moderate-to-severe psoriasis or psoriatic arthritis, biologics often stand as the most potent treatment option.

Consistency is key when using biologics, as continuous use tends to maximize their effectiveness.

On the other hand, interrupting the treatment can lead to a reduced effectiveness of the biologic and potentially trigger certain side effects.