If you have moderate to severe psoriasis, your doctor may prescribe a biologic drug to help treat it. Psoriasis can cause red, pink, brown, or purple patches, depending on your skin tone. These patches often have silvery scales and can be itchy and painful. Doctors aren’t sure what causes psoriasis, but they know it’s linked to an overactive immune system that makes skin cells grow too fast. The extra cells pile up and form patches called plaques. Biologic medications treat psoriasis by targeting parts of 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.

What Are Biologics, and How Do They Work?

Biologics are medicines made from living sources, such as proteins or cells from humans, animals, or microorganisms. Biologic therapy is used to treat certain infections, some cancers, and autoimmune diseases. Psoriasis is a skin condition that can be successfully treated with biologics. Biologic drugs are usually used to treat moderate to severe psoriasis. They may also be an option if other treatments, like topical creams or ointments you apply to your skin, haven’t helped enough.

“You’re trying to 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. Alexa Kimball

“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:

• Tumor necrosis factor-alpha (TNF-alpha) inhibitors
• Interleukin (IL)-12 and -23 (IL-12/23) inhibitors
• IL-23 inhibitors
• IL-17 inhibitors
• IL-36 pathway inhibitors (used only for generalized pustular psoriasis, a rare and severe type of 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.”

FDA-Approved Biologics To Treat Psoriasis

The following medications are approved by the U.S. Food and Drug Administration (FDA) to treat psoriasis:

• Adalimumab (Humira)
• Bimekizumab (Bimzelx)
• Brodalumab (Siliq)
• Certolizumab pegol (Cimzia)
• Etanercept (Enbrel)
• Guselkumab (Tremfya)
• Infliximab (Remicade)
• Ixekizumab (Taltz)
• Risankizumab (Skyrizi)
• Secukinumab (Cosentyx)
• Spesolimab (Spevigo)
• Tildrakizumab (Ilumya)
• Ustekinumab (Stelara)

All of the medications above, except for tildrakizumab, brodalumab, and spesolimab, are also FDA-approved to treat psoriatic arthritis. Spesolimab only treats generalized pustular psoriasis.

How Biologic Drugs Are Given

Biologic treatments for psoriasis are given by injection under the skin or by intravenous infusion, which delivers medicine into a vein. Depending on the treatment, the drug can be given at home or in a healthcare setting. Biologics cannot be taken by mouth because the body wouldn’t absorb them well through the digestive system.

“Now we’re at a point where 85 percent to 90 percent are successful, and a huge number of those are also completely clear [when taking biologics]. It’s been incredible.”

— Dr. Alexa Kimball

Recently, biosimilars have entered the market, offering a more affordable treatment option for psoriasis. Biosimilars are FDA-approved biologic medicines that are highly similar to an existing biologic. There are several biosimilars for psoriasis. Your doctor can explain the options.

Benefits of Biologics

There are many potential benefits of using biologics to treat psoriasis. Talk to your doctor about what improvements you might see and how soon you may notice them.

Skin Clearance

Biologics can help some people with psoriasis clear their skin completely. In early studies of the first biologics, about 35 percent of people had clear or nearly clear skin. Later studies of newer biologics found that number was closer to 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.”

Controlling Inflammation

Biologics can ease inflammation throughout the body, which may lower your risk of other inflammation-related health problems. 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.

Treating Joint Symptoms

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 conditions.

Convenience

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.

Drawbacks of Biologic Drugs

All medicines can have side effects and risks. It’s important to weigh the risks and benefits with your dermatologist before starting a biologic. Below are some possible drawbacks of using biologics.

Infection Risk

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.”

Cost

Biologics are also expensive, said Dr. Kimball. They can cost tens of thousands of dollars per year. Talk to your insurance provider about coverage for biologic drugs. You may have to get prior authorization for them to be covered. The drug manufacturer may also offer help to lower your copay. You can also ask your doctor about biosimilar options.

Needles

Another drawback is that biologic drugs must be given as an intravenous infusion or as an injection, which may not appeal to some people with psoriasis. “That can be both intimidating and uncomfortable,” said Dr. Kimball.

Cold Storage

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.

Diminishing Benefits Over Time

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.”

Side Effects

Biologic drugs are considered safe and are generally well tolerated. However, every medication has side effects. Common side effects for biologic drugs include irritation or reactions at the injection site, headache, nausea, and infection. Tell your dermatologist and healthcare team right away if you notice any signs of a serious infection. These may include:

• Fever or chills
• Muscle pain or tingling
• Rash or painful sores
• Diarrhea or abdominal pain
• Abnormal urination

Talk With Your Doctor

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.

Join the Conversation

On MyPsoriasisTeam, people share their experiences with psoriasis and psoriatic arthritis, get advice, and find support from others who understand.

Do you take biologics to treat your psoriasis? Let others know in the comments below.