• Biologics are a class of drugs used to target specific cells and proteins in the immune system.
• Biologic drugs are typically used to treat moderate to severe psoriasis.
• Biologic treatments are administered by injection or intravenous (IV) infusion.

Biologics are a class of drugs used in the treatment of psoriasis to target specific cells and proteins in the immune system. Although the exact causes of psoriasis are not fully understood, one factor is an overactive immune system, which causes disorders in skin cells. Due to an overproduction of skin cells, people with psoriasis develop skin lesions — also called plaques — that can become red or purple thickened patches with silvery scales. The condition can be itchy and painful, and it often has a negative impact on quality of life.

MyPsoriasisTeam members frequently share their experiences with biologic drugs. “Over 80 percent of my body was covered with psoriasis,” one member wrote. “Three years ago, I started using biologics. Since then, I have been over 95 percent clear of the psoriasis.”

“There are many different biologics and everyone responds differently,” one member commented. Another member wrote, “I also take a biologic and have been on it for two years or so. Once my skin cleared, it felt amazing. I felt amazing.”

To learn more about biologics and the treatment of psoriasis, MyPsoriasisTeam spoke with Dr. Alexa B. Kimball, CEO and president of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center in Boston, Massachusetts. Dr. Kimball is also a professor of dermatology at Harvard Medical School. She has widespread experience in the development of drugs, has published more than 300 medical articles, and has conducted more than 150 clinical trials.

“It has been an incredible story,” Dr. Kimball said about how biologics have impacted psoriasis treatment strategies. “When I started doing research and treating psoriasis patients, we were just on the cusp of starting to use them.” Initially, 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.”

What Are Biologics and How Do They Work?

Biologic drugs, sometimes called biologic agents, are compounds that may include proteins, nucleic acids, or living cells derived from humans, animals, or microorganisms. They are produced through complex techniques that have been developed through biotechnology and genetic research. Biologic therapy is used in the treatment of a number of chronic autoimmune conditions, such as psoriasis, psoriatic arthritis, rheumatoid arthritis, Crohn’s disease, and ulcerative colitis, among others.

Biologics differ from other drugs like cyclosporine or methotrexate, which are used in the treatment of psoriasis to suppress the immune system more broadly. Each group of biologics targets a particular type of proinflammatory protein and blocks, or inhibits, its ability to overreact in the immune system. Three main groups of biologic drugs are used to treat psoriasis:

• Tumor necrosis factor-alpha (TNF-alpha) inhibitors, which target inflammatory cytokines
• Interleukin-23 inhibitors
• Interleukin-17 inhibitors

“They're designed to be an antibody or a reaction to something that is driving your psoriasis in your skin,” Dr. Kimball explained. “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,” she said. “But they're targeted because they're just hitting a very specific place.”

Some common biologics used to treat psoriasis include:

• Cimzia (certolizumab pegol)
• Cosentyx (secukinumab)
• Enbrel (etanercept)
• Humira (adalimumab)
• Ilumya (tildrakizumab-asmn)
• Remicade (infliximab)
• Skyrizi (risankizumab-rzaa)
• Stelara (ustekinumab)
• Taltz (ixekizumab)
• Tremfya (guselkumab)

How Biologic Drugs Are Administered

Biologic treatments are administered by injection or IV infusion because they consist of large molecules that cannot be properly absorbed orally. The compounds are also complex and fragile, making them unstable in the gastrointestinal system.

Injection or infusion, depending on the specific drug, can be administered in a clinical setting. Many biologic drugs that can be absorbed under the skin, or subcutaneously, can also be self-injected at home.

Researchers are aiming to develop drugs that work like biologics, but which could potentially be taken orally, Dr. Kimball said. “We still have areas of research for oral treatments that are potentially more convenient and maybe less expensive over time,” she explained. “So there's some good work going on and some new approaches there.”

Benefits of Biologics

Biologic drugs are typically used for moderate to severe psoriasis. When topical treatments, phototherapy, and other types of systemic therapy do not adequately control symptoms, biologics may be an appropriate treatment option. Biologic drugs are considered safe and are generally well tolerated.

As biologic drugs have become more potent, they have not posed higher risks for adverse effects, Dr. Kimball said. “Most of the time in medicine, we think, well, there's more potency, there are going to be more safety risks. But we made it through, especially the last three or four years, with really effective medicines that — at the moment — don't seem to have more safety problems,” she said. “So that is just great news for patients. They can ideally forget they have the disease.”

Drawbacks of Biologic Drugs

People who take biologic drugs have an increased risk of infection, Dr. Kimball explained. “They're tweaking with your immune system,” she said. “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. Some insurance plans may cover the cost of biologics, but for some people, the out-of-pocket expense may be prohibitive.

Another drawback is that biologic drug administration requires IV infusion or an injection, which may not appeal to some people with psoriasis. “That can be both intimidating and uncomfortable,” said Dr. Kimball.

Diminishing Benefits Over Time

Biologics can lose their effectiveness over time in some cases, Dr. Kimball said. “We don't totally understand that,” she noted. “They could be really clear at the beginning, and then all of a sudden, or gradually, the psoriasis comes back.”

There are a few possible explanations for why biologics stop being effective over time, Dr. Kimball explained. One reason could be that the immune system may begin to compensate for them. Another reason could be that the body starts to consume the drug 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.”

People with psoriasis sometimes need to try another biologic when one stops working. This can be frustrating, as MyPsoriasisTeam members have discussed. “I was on Humira for years then it stopped working,” a member said. “Now I’m on Cosentyx, and after three years, it stopped working.” Another member said, “I’m constantly itching and annoyed that my biologic has stopped working.”

Side Effects

Common side effects for biologic drugs include irritation and reaction at the site of injection, headache, nausea, and infection. Signs of serious infection should be quickly reported to your dermatologist and health care team. These may include:

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

Talk With Others Who Understand

MyPsoriaisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 91,000 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 experience in the comments below, or start a conversation by posting on your Activities page.

References

1. Biologics — National Psoriasis Foundation
2. Psoriasis — Mayo Clinic
3. What Are "Biologics" Questions and Answers — U.S. Food and Drug Administration (FDA)
4. Biologic Therapy for Autoimmune Diseases: An Update — BMC Medicine
5. Efficacy and Safety of Cyclosporine versus Methotrexate in Severe Psoriasis: A Study From North India — Journal of Dermatology
6. Efficacy and Safety of Biologics for Psoriasis and Psoriatic Arthritis and Their Impact on Comorbidities: A Literature Review — International Journal of Molecular Sciences
7. Biological Agents for Psoriasis — DermNet NZ
8. Biologics: The Role of Delivery Systems in Improved Therapy — Biologics: Targets and Therapy
9. A Portfolio of Biologic Self-Injection Devices in Rheumatology: How Patient Involvement in Device Design Can Improve Treatment Experience — Drug Delivery
10. Psoriasis Treatment: Biologics — American Academy of Dermatology Association
11. Biological Therapy of Psoriasis — Indian Journal of Dermatology
12. Why Biologics and Biosimilars Remain So Expensive: Despite Two Wins for Biosimilars, the Supreme Court's Recent Rulings Do not Solve Fundamental Barriers to Competition — Drugs
13. Biological Therapy for Cancer — Mayo Clinic
14. Biologics — Arthritis Foundation