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.
“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.
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.”
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 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 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.
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:
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:
Some commonly prescribed IL-23 inhibitors, also approved by the FDA, include:
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.
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.
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.
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Are you on prescribed injectable psoriasis medications? Share your experience in the comments below, or start a conversation by posting on your Activities page.