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Injections for Psoriasis Treatment

Posted on May 27, 2021
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Susana Restrepo, Ph.D.

Injections are a common treatment option for people living with psoriatic arthritis (PsA) or moderate to severe psoriasis. They are commonly prescribed to individuals who have not responded to other treatment options, like oral medications, topicals or phototherapy.

Some MyPsoriasisTeam members have expressed curiosity about the effectiveness of injectable medications for psoriasis and PsA. “Has anyone been on psoriasis injections?” one member asked. “Is it for a lifetime? Does it clear the skin for good, or just manage it?”

This article will explore the answers to these questions. It will also provide a summary of commonly injected medications and explore their benefits and drawbacks.

Understand the Differences in Injectable Medications

“Is the injection a good move or a bad one?” asked one MyPsoriasisTeam member.

There isn’t a simple answer to that question. There are various injectable medications used for different types of psoriatic disease. Your doctor may have to run some medical tests before determining which injectable medication is appropriate for you. Injectable medications for psoriasis may include corticosteroids, immunomodulators, or biologics.

A corticosteroid like Kenalog (triamcinolone acetonide) can be delivered into the joint of a person to treat psoriatic arthritis. It can also be locally injected subcutaneously — under the skin. Immunomodulators like methotrexate can be injected subcutaneously. Biologics may be prescribed in conjunction with methotrexate or as stand-alone treatment. Humira (adalimumab) is one of the most popular biologics, and it is also injected subcutaneously. Other biologics, such as Remicade (infliximab), are delivered through an IV.

How Do Injectable Medications Work?

Psoriasis is an immune system malfunction where the immune system is overactive and produces inflammation. Injectable medications provide relief by tackling different factors that contribute to inflammation — which is also described as the medication’s “mechanism of action.”

Corticosteroids

When an immune response is triggered, cytokines are produced. Cytokines are small proteins that cause an inflammatory response. Corticosteroids block the production of these cytokines. In this way, they reduce inflammation.

Methotrexate

Methotrexate is a disease-modifying antirheumatic drug (DMARD) sold under several brand names, including Otrexup and Rasuvo. It casts a wide net on the immune system and targets several pathways in the inflammatory response.

Biologics

Biologics are more selective than methotrexate. They target a specific protein or cell of the immune system that contributes to the development of psoriasis and PsA. Biologics vary by how they work on the body and how they are administered.

People living with psoriasis can produce types of cytokines in excess, including tumor necrosis factor alpha (TNF-alpha) and specific interleukins (ILs): IL-12, IL-17, and IL-23. Inhibitors of these proteins decrease inflammation.

TNF-Alpha Inhibitors

Following is a list of commonly prescribed TNF-alpha inhibitors, all of which have been approved by the U.S. Food and Drug Administration (FDA) and indicated for treatment of psoriasis, PsA, or both, as noted:

  • Cimzia (certolizumab pegol) — Indicated for the treatment of psoriasis and psoriatic arthritis and administered subcutaneously
  • Enbrel (etanercept) — Indicated for treating psoriasis and PsA and administered subcutaneously
  • Erelzi (etanercept-szzs) — A biosimilar (a biologic drug that uses a previously approved biologic as a reference) that’s indicated for the treatment of psoriasis and PsA and administered subcutaneously
  • Humira (adalimumab) — Indicated for treating psoriasis and PsA and administered subcutaneously
  • Inflectra (infliximab-dyyb) — A biosimilar indicated for the treatment of psoriasis and psoriatic arthritis and administered by IV
  • Remicade (infliximab) — Indicated for treating psoriasis and PsA and administered by IV
  • Renflexis (infliximab-abda) — A biosimilar indicated for the treatment of psoriasis and psoriatic arthritis and administered by IV
  • Simponi (golimumab) — Indicated for PsA and administered subcutaneously
  • Simponi Aria (golimumab) — Indicated for PsA and administered by IV

Interleukin Inhibitors

One commonly prescribed FDA-approved IL-12 inhibitor is Stelara (ustekinumab), indicated for the treatment of psoriasis and psoriatic arthritis and administered subcutaneously.

Commonly prescribed IL-17 inhibitors that have secured FDA approval include:

  • Cosentyx (secukinumab) — Indicated for the treatment of psoriasis and psoriatic arthritis and administered subcutaneously
  • Siliq (brodalumab) — Indicated for treating psoriasis and also administered subcutaneously
  • Taltz (ixekizumab) — Indicated for psoriasis and PsA and given subcutaneously

Some commonly prescribed IL-23 inhibitors, also approved by the FDA, include:

  • Ilumya (tildrakizumab-asmn) — Indicated for the treatment of psoriasis and administered subcutaneously
  • Skyrizi (risankizumab-rzaa) — Indicated for treating psoriasis and administered subcutaneously
  • Stelara (ustekinumab) — Indicated for treating psoriasis and psoriatic arthritis and administered subcutaneously
  • Tremfya (guselkumab) — Indicated for psoriasis and PsA and administered subcutaneously

T cells are immune cells that produce cytokines and other inflammatory factors. T-cell inhibitors block the ability of these cells to produce inflammation. Orencia (abatacept) is indicated for the treatment of psoriatic arthritis by the FDA and is administered subcutaneously or by IV.

Know the Benefits, Side Effects, and Risks of Injectables

Members of MyPsoriasisTeam have found injectable medications to be effective. “I have been on Enbrel for a few years now with no problem. I tried everything. Enbrel is the only thing that has helped me,” one member shared. “I get regular blood tests and have had no problems. I have been clear since I started taking it.”

However, since all of these agents suppress parts of the immune system, they come with risks and potential serious side effects. Your dermatologist or rheumatologist can provide medical advice to help you determine which injectable is right for you.

The overuse of corticosteroids in joints, for example, can cause soft tissue damage. Methotrexate increases one’s risk of cancer.

Continuous use of a biologic can be the most effective treatment option for people with moderate to severe psoriasis. However, there are possible side effects of stopping and starting treatment. Some biologics can stop working after a long time. Risks such as developing serious infections (bacterial, fungal, or viral) are also a concern.

Additionally, biologics may be the most costly treatment option. Biosimilars are less costly than the reference biologic they are based on.

Bear in mind that not every biologic works for everyone. If one does not work for you, don’t lose heart. Another may be very effective.

Getting the Injection

Some medications are administered by a health care professional. Others require self-administration, either by you or a caregiver. Subcutaneous injections can be given at home and are specifically designed to be easily injected without assistance. IV medications require you to go to a doctor’s office or an infusion center. It is common for injections to cause bruising at the injection site.

Although self-administration can cause anxiety, many in the MyPsoriasisTeam community have overcome this hurdle and are comfortable with self-administration. You can read more about overcoming the fear of self-injections for psoriasis.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis, and their loved ones. On MyPsoriasisTeam, more than 93,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis and psoriatic arthritis.

Are you on prescribed injectable psoriasis medications? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References

  1. Psoriasis — Mayo Clinic
  2. Biologics — National Psoriasis Foundation
  3. Effects of Topical Treatment With Budesonide on Parameters for Epidermal Proliferation, Keratinization and Inflammation in Psoriasis — Journal of Dermatological Science
  4. Disease Modifying Anti-Rheumatic Drugs (DMARD) — StatPearls
  5. The Role of T Cells in Psoriasis — Journal of the European Academy of Dermatology and Venereology
  6. Cortisone Shots — Mayo Clinic
  7. Methotrexate Injection — Johns Hopkins Arthritis Center
  8. The Cost of Biologics for Psoriasis is Increasing — Drugs in Context
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Susana Restrepo, Ph.D. is a medical and scientific writer with a Ph.D. in pharmacology from the University of Colorado. Learn more about her here.

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