If you’re living with moderate to severe psoriasis, your doctor may suggest medications such as biologics or methotrexate, especially if topical treatments or ointments haven’t helped you achieve skin clearance (when all signs of psoriasis are gone). Both methotrexate and biologic treatments affect the immune system, but they work in different ways. Understanding how they work can help you and your doctor decide which treatment option is right for you.

Here’s some information about biologics and methotrexate that you can discuss in more detail with your dermatology team.

Methotrexate Suppresses the Immune System

Methotrexate is a type of medication known as an antimetabolite. This type of drug works by blocking a cell’s ability to replicate (copy itself). In people with psoriasis, the immune system causes too much inflammation. This makes skin cells grow too quickly. This can lead to symptoms such as painful scales and plaques on the skin, which are common in plaque psoriasis. Methotrexate helps to slow down the immune system, which decreases the production of abnormal skin cells.

Doctors also use methotrexate to treat other health conditions, including other autoimmune conditions, such as rheumatoid arthritis, and some types of cancer. It was approved by the U.S. Food and Drug Administration (FDA) for the treatment of psoriasis in 1972.

You can take methotrexate as a pill, a liquid, or an injection.

Biologics Target Specific Parts of the Immune System

Biologics are a newer type of medication. There are different kinds, including tumor necrosis factor (TNF) inhibitor drugs and interleukin (IL) inhibitors. Biologic drugs are made from live cells. They work by blocking certain proteins in the immune system that cause inflammation. Each biologic drug targets a specific part of the immune system. Each biologic medication targets a specific part of the immune system. The FDA has approved more than a dozen biologics to treat psoriasis and psoriatic arthritis.

There are also biosimilar medications available to treat psoriasis. Biosimilars are FDA-approved drugs that resemble biologics but can be made by different manufacturers once the original patent expires. Biosimilars are carefully tested to make sure they are just as safe and effective as the original biologic. Your doctor can help explain your options.

Biologic and biosimilar medications are usually given as injections. Some are given as infusions through a vein. Both biologic medications and methotrexate are systemic treatments that affect the body as a whole. They are also known as disease-modifying antirheumatic drugs (DMARDs).

Is One Drug More Effective Than the Other for Psoriasis?

Studies show that biologic therapy usually works better than methotrexate for psoriasis and psoriatic arthritis. Still, psoriasis affects everyone differently, and what works for one person may not work for someone else. Although biologics can be effective for many people living with psoriasis, they don’t always work for everyone.

Potential Side Effects

Every medication comes with a risk of side effects. It’s important to discuss possible side effects with your doctor before starting any medication. Once you start taking medication, follow up with your doctor if side effects impact your quality of life. Both methotrexate and biologics affect the immune system and increase the risk of infections. Some of these infections can be serious.

Methotrexate Side Effects

Methotrexate can cause a number of side effects. Doctors usually prescribed folic acid (a type of B vitamin) to help reduce some of these side effects. Common side effects linked to methotrexate include:

• Headache
• Vomiting and diarrhea
• Hair loss
• Mouth sores
• Shortness of breath (difficulty breathing)
• Skin rash

More serious side effects include:

• Fever or sweating
• Sore throat or cough
• Stomach pain
• Jaundice (yellowing of eyes or skin)
• Unexpected bruising or bleeding
• Changes in urination
• Lung inflammation
• Allergic reaction

Methotrexate can lower the number of blood cells in your body. To catch this early, your doctor will do regular blood tests.

Side Effects of Biologics

Biologic drugs can have different side effects, depending on which one you take. Your doctor will monitor you for serious side effects. Most side effects are mild and include:

• Irritation at the injection site
• Headache
• Urinary tract infection (UTI)
• Upper respiratory infection (like a cold)
• Flu-like symptoms

Signs of infection that require immediate medical attention include:

• Shortness of breath
• A rash that spreads across your body
• Chills or shaking
• Itchy eyes or lips

Which Medication Is Better for You?

Talk to your doctor about which treatment is right for you. They’ll look at your medical history and symptoms to help you choose the safest and most effective option.

Some people should not take methotrexate. This includes people with kidney disease, liver disease, and lung disease. People who are trying to get pregnant, already pregnant, or breastfeeding should also avoid taking methotrexate.

Biologics can also be very expensive compared to methotrexate, depending on your health insurance coverage. Some insurance plans may require you to try a less expensive treatment option before they’ll cover biologic treatment.

Find Your Team

On MyPsoriasisTeam, the social network for people living with psoriasis and psoriatic arthritis, members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Have you tried methotrexate or biologics? Share your experience in a comment below, or start a conversation by posting on your Activities page.