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If conventional treatments aren’t keeping your psoriatic arthritis (PsA) under control — or if you have extensive joint damage — your doctor may prescribe a type of medication called biologics. A type of disease-modifying antirheumatic drug (DMARD), biologics work by targeting specific cells or proteins that cause inflammation.
Here are seven things to know about using biologics for PsA.
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Biologic drugs work by suppressing parts of your immune system. While this helps to tamp down inflammation, it also decreases your ability to fight off infections.
Before prescribing a biologic, your doctor will screen you for certain infections. You should let your care team know if you currently have an infection or if you’ve recently visited places where fungal infections are common.
In addition, don’t start taking a biologic if you’re sick. Your doctor will give you a blood test for tuberculosis, hepatitis B, and hepatitis C infections. If you have them, they must be treated before you can start biologic therapy.
To prevent infections while you’re taking a biologic, make sure you’re up to date on all of your vaccines before you start using the medication. This is especially important because while you’re using a biologic, you can’t get a live vaccine such as the measles vaccine. Consult with your healthcare provider about your vaccine history.
Biologics are drugs that target parts of the immune system to stop it from overreacting. In autoimmune diseases like PsA, the immune system mistakenly targets the joints. It attacks them the same way it would go after a foreign invader, like bacteria. Biologic treatments work by interrupting different parts of the inflammation cycle to stop the damage.
Following are a few biologic types your doctor may prescribe for PsA.
Tumor necrosis factor (TNF)-alpha inhibitors block the TNF-alpha protein. TNF-alpha plays a central role in inflammation by promoting inflammatory signals and activating immune cells, including T cells. Targeting TNF-alpha can help to stop the inflammation process.
TNF-alpha inhibitors are recommended as a first-line treatment by the American College of Rheumatology and the National Psoriasis Foundation guidelines for psoriatic arthritis.
TNF-alpha inhibitors approved by the U.S. Food and Drug Administration (FDA) to treat PsA include:
Interleukin (IL) inhibitors have antibodies that target different types of interleukins. Interleukins are a type of protein that activates white blood cells, causing inflammation. The interleukin inhibitors currently available to treat PsA target either IL-12, IL-17, or IL-23.
FDA-approved IL-23 inhibitors include:
FDA-approved IL-17 inhibitors include:
T-cell inhibitors reduce inflammation by blocking overactive T cells that can damage the tissue in your joints. T cells are a type of white blood cell that can cause inflammation in PsA.
Abatacept (Orencia) is currently the only drug in this category that is FDA approved to treat PsA.
Biologics can’t be swallowed, like a pill. The special proteins would be destroyed in your stomach by the digestive process. Instead, they must be infused into a vein or injected subcutaneously (under the skin).
Infusions are usually given at a healthcare facility. If you are prescribed a subcutaneous injection, you can give it to yourself at home, usually in the stomach or thigh. Your doctor or pharmacist will teach you how to use your medication.
How often you take a biologic varies from twice weekly to once every 12 weeks depending on the specific drug and the severity of your condition.
Biologics can be a life-changing treatment to control joint pain, stiffness, and swelling caused by PsA. However, it can take up to three months before you start to feel an improvement.
Many biologics can be used with other PsA treatments, such as nonsteroidal anti-inflammatory drugs (NSAIDs), to control pain until the biologic has time to take effect.
However, if you find you still need to take pain medications frequently after three months, it may be a sign the biologic isn’t working for you or that there’s another cause for your pain.
Biologics tend to work best if you take them continuously. If you stop and start, they may not work as well and you may experience side effects.
In clinical trials, biologics have been shown to be safe and tolerable for most people. However, all medications have possible side effects. For most people, they’re not serious enough to stop the medication.
The most common side effects with biologics include:
Although serious side effects are rare, you should be aware of the following when taking biologics:
The possible side effects of biologics can be intimidating, so it’s important to weigh the benefits and risks with your healthcare provider. Uncontrolled inflammation associated with PsA can have serious consequences as well, including causing disability and reducing your quality of life.
One MyPsoriasisTeam member said, “I started using biologics because I was more afraid of what would happen to my body if I didn’t control the damage. We all make the call for ourselves.”
It’s possible for a biologic to stop working after you have been taking it for a while. One MyPsoriasisTeam member said, “Biologics work great for me until they don’t.”
Your body can counteract the effect of a biologic if your immune system develops antibodies to the proteins in the medication. You should also be aware that your symptoms can flare up while using a biologic. A MyPsoriasisTeam member shared, “Even with the biologic working, I can still flare.”
If one biologic stops working, your doctor may recommend switching to a different one. There is also some evidence that oral DMARDs like methotrexate can prevent the development of antibodies against biologics and make the effects last longer.
The cost of treatment is a major concern for people using biologics. One study found that biologics used to treat PsA cost between $22,000 and $54,000 per year.
Although biologics are expensive, most insurance plans will cover these drugs. If you are prescribed a biologic, call your insurance plan directly to ask whether it’s covered and what your out-of-pocket costs might be. You may also be able to get help with the cost of your medication through the drug manufacturer.
Biosimilar medications may be less expensive than the original branded medication. These are medications that are modeled after a brand name drug that is already in use. The FDA approval process for biosimilars ensures there are no clinical differences from the branded medication, and the biosimilar medication is as safe and effective as the medication it’s modeled after.
On MyPsoriasisTeam, people share their experiences with psoriasis and psoriatic arthritis, get advice, and find support from others who understand.
Are you taking a biologic drug for PsA? Let others know in the comments below.
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A MyPsoriasisTeam Member
I've been on Humera for almost 2 years. It works great, but I have frequent and serous infections. I do not go in stores and wear a mask at the Dr office. Any suggestions?
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