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Got psoriasis? Chances are, you’re taking a biologic drug to help treat it. Psoriasis causes red or purple skin patches with silvery scales. These patches can also be itchy and painful. Doctors aren’t sure what exactly causes psoriasis, but they do know that an overactive immune system can lead to the body making too many skin cells. These extra cells pile up and form patches called plaques. Biologic medications treat psoriasis by targeting the immune system to reduce inflammation and slow the growth of skin cells. If you’re taking these medicines, you should know the benefits and potential side effects.
Biologics are drugs made from proteins, nucleic acids, or cells from humans, animals, or microorganisms. Today, biologic therapy is used to treat many infections, cancers, and autoimmune diseases. Psoriasis is a skin condition that biologics can successfully treat. Biologic drugs are typically used to treat moderate to severe psoriasis, or when other treatments like topicals — creams or ointments you put on your skin — haven’t worked.
“It has been an incredible story,” said Dr. Alexa Kimball, MD, MPH, president of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center and professor of dermatology at Harvard Medical School. “When I started doing research and treating psoriasis patients, we were just on the cusp of starting to use biologics.” Today, they’re considered a mainstay of psoriasis treatment.
Each group of biologics targets a specific protein that causes inflammation and helps stop it from overreacting in the immune system. There are five types of biologic drugs used to treat psoriasis:
“You’re trying to basically take a ‘sponge’ and either suck up some of the chemicals that are making all the inflammation, or you’re trying to block them in some way,” Dr. Kimball explained. “But they’re targeted because they're just hitting a very specific place.”
The following medications are approved by the U.S. Food and Drug Administration (FDA) to treat psoriasis:
All of the medications above, with the exception of tildrakizumab, brodalumab, and spesolimab, are also FDA-approved to treat psoriatic arthritis.
Biologic treatments for psoriasis are given by injection underneath the skin or through an intravenous (IV) infusion (into a person’s vein). Depending on the treatment, the drug can be given at home or in a healthcare setting. They cannot be taken by mouth because the body wouldn’t absorb them well through the digestive system.
Recently, biosimilars have entered the market, offering a more affordable treatment option for psoriasis. Biosimilars are FDA-approved drugs made from living cells that resemble biologics but can be made by different manufacturers after the original product’s patent expires. They are tested to ensure they have the same safety, action, and effectiveness as the biologic. There are several biosimilars available for psoriasis. Your doctor can explain the options.
There are many potential benefits of using biologics to treat psoriasis. Talk to your doctor about what improvements you can expect and when you can expect them.
Biologics can help some people with psoriasis clear their skin completely. At first, the success rate for people finding symptom relief with biologics was 35 percent, then 50 percent, Dr. Kimball explained: “Now we’re at a point where 85 percent to 90 percent are successful, and a huge number of those are also successful in being completely clear. It’s been incredible.”
Biologics address inflammation throughout the body, so they may reduce the chances of developing other health conditions associated with inflammation. For example, some studies found that rates of psoriatic arthritis were lower in people with psoriasis who were treated with biologics or other treatments that affect the entire immune system, compared to those who weren’t.
Many of the biologics used to treat psoriasis are also used for psoriatic arthritis. That means biologics may help relieve joint pain and swelling if you already have those problems.
Depending on the drug, biologics are taken once every few weeks. This can be more convenient than daily pills or topical treatments. Topical treatments can also be messy and time-consuming to apply.
There are potential risks to using any medication. It’s important to weigh the risks and benefits with your dermatologist. Below are some possible drawbacks of using biologics.
People who take biologic drugs have an increased risk of infection, Dr. Kimball explained: “They're tweaking your immune system. We watch for infection, primarily, as the major thing that we’re keeping an eye on.”
Biologics are also expensive, said Dr. Kimball. The average cost for biologic drugs is between $10,000 and $30,000 per year. Although certain insurance plans may cover the cost, the out-of-pocket expense can still be too high for many people.
Another drawback is that biologic drugs must be given as an IV infusion or as an injection, which may not appeal to some people with psoriasis. “That can be both intimidating and uncomfortable,” said Dr. Kimball.
Biologics must also be kept cold. Storing these drugs properly can be inconvenient for many people, since they often need to be kept in the refrigerator or handled carefully. It’s best to check the product’s package label or ask your doctor’s office about safe handling and storage.
Biologics can lose their effectiveness over time. Dr. Kimball noted, “We don’t totally understand that. They could be really clear at the beginning, and then all of a sudden, or gradually, the psoriasis comes back.”
People with psoriasis sometimes need to try another biologic when one stops working. This process can be frustrating, as MyPsoriasisTeam members have discussed. “I was on a biologic for years, then it stopped working,” a member said. Another member shared, “I’m constantly itching and annoyed that my biologic has stopped working.”
According to Dr. Kimball, there are a few reasons why biologics might stop working as well over time. One reason is that the immune system may adjust to the drug. Another reason is that the body might start to break it down faster. A third reason could be that people may need to stay on higher doses of biologics. "Most of the drugs actually start at higher doses and then we try to taper them down over time," she said. “And some patients just need the higher dose for longer periods.”
Biologic drugs are considered safe and are generally well tolerated. However, every medication has side effects. Common side effects for biologic drugs include irritation and reaction at the site of injection, headache, nausea, and infection. Tell your dermatologist and healthcare team right away if you notice any signs of a serious infection. These may include:
Living with psoriasis can be challenging, but understanding your treatment options puts you in a better position to manage it. Biologics may not work for everyone, but for those they help, they can be a key part of long-term care. Staying open to regular check-ins, asking questions, and speaking up about changes in your symptoms can help you and your care team get the best results from your treatment.
On MyPsoriasisTeam, the social network for people with psoriasis and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.
Are you living with psoriasis? Do you have experience with or questions about biologics? Share your story in the comments below, or start a conversation by posting on your Activities page.
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I use petroleum jelly on my eyelids. The skin is abnormally wrinkled and feels very tight first thing in the morning.
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