3 Reasons Why a Dermatologist Might Recommend Biologics | MyPsoriasisTeam

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3 Reasons Why a Dermatologist Might Recommend Biologics

Medically reviewed by Noah Levit, M.D., Ph.D., FAAD
Written by Alison Channon
Posted on February 5, 2024

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If you have psoriasis, specific parts of the immune system are overactive,1 explained Dr. Adel Haque, a board-certified dermatologist in Pennsylvania. Dr. Haque uses a highway metaphor to explain the immune system: “You have highways in your body that are really upregulated,” which leads to symptoms like skin plaques or joint pain. “That traffic’s got to go down … for the psoriasis to get better.” These busy “highways” of psoriasis can be treated with many different medications.

Enter biologics (one of the treatment options for psoriasis) — medicines produced from biological sources. These medications include treatments for a broad range of conditions, including moderate to severe psoriasis and active psoriatic arthritis.2,3 Biologics have a very specific mode of action and target a particular area of the immune system that is mistakenly activated, while leaving others undisturbed.3 If traffic speeding down a specific “highway” in your immune system is causing your psoriasis, Dr. Haque said, “biologics put a tollbooth on that highway.”

Transcript

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Dr. Haque
Psoriasis is an inflammatory condition where the immune system creates excess inflammation, affecting the body's normal self-regulation. Biologics are injectable medications that can decrease inflammation throughout the body by targeting the overactive portion of the immune system. Here are three reasons why I might recommend biologics to my psoriasis patients. Number one, biologics may offer a single treatment that has the ability to stay effective over a long period of time and are dosed anywhere from every week to every 12 weeks.

00:00:30:21 - 00:00:57:20
Dr. Haque
Two, biologics, like other treatments that work systemically throughout the body, treat the skin symptoms that you see and the inflammation inside the body that you can't see. Number three, it's possible that treating systemic inflammation with biologics may reduce the risk of developing other health problems related to psoriasis. By reducing inflammation in the body, we have hope that it means we're all to reducing the likelihood that someone may develop another systemically driven inflammatory condition.

00:00:57:22 - 00:01:25:20
Dr. Haque
We're still learning a lot about this concept. In the short term, I see my patients develop confidence with biologic treatments. I see them achieve a positive attitude towards their skin, which they may not have had since their symptoms started. Talk to your dermatologist about the various treatments available to you. These medications may help you get your psoriasis and internal inflammation under control.

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If you’re wondering if biologics are right for you, read on for three reasons Dr. Haque would recommend biologics to people with moderate to severe psoriasis.

1. Use a Single Treatment That Requires Infrequent Dosing With the Ability To Be Effective for a Long Time

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Biologic drugs that are approved for psoriasis have dosing schedules that can range anywhere from an injection once weekly to once every 12 weeks. Many can be administered at home, and some have the option to be given at a doctor’s office.4 Unlike topical treatments like creams or lotions, biologics don’t require daily or even more frequent application to your skin.5,6

Biologic therapy provides “highly effective treatment that can last over a long period of time that you don’t have to take on a daily basis,” Dr. Haque said. Using a biologic can eliminate the need for a complicated or time-consuming regimen of topicals, he added.

The thought of regular injections may be nerve-wracking — if this describes how you feel, you’re not alone. Tell your dermatologist or another health care provider if you have a fear of needles. They can help you find ways to make the process less stressful.7

2. Treat Psoriasis Systemically

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Psoriasis is caused by overactivity in the immune system. When your immune system gets triggered into action, this can lead to inflammation inside the body. This is beneficial when your immune system is fighting a cold or flu, but in the case of psoriasis, the body creates inflammation that results in symptoms like skin plaques. The inflammation that leads to skin symptoms may have effects throughout the body.1

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Biologics are systemic medications, meaning they treat inflammation throughout the body, as opposed to focusing only on a specific area where you might have skin plaques. A topical cream is applied on areas of the skin where there are psoriasis lesions. A topical is an example of a medication that’s used reactively, not used systemically.8,9 “Unmanaged psoriasis … [is] inflammation in the body that’s not being treated,” Dr. Haque said. Biologics, he explained, “treat your disease systemically to help you get the inflammation under control,” including the inflammation “you can’t see.”10

While biologics are systemic medications, they’re also highly targeted. “We just want to target the overactive portion of the immune system and bring it back to normal,” Dr. Haque said. It’s important to talk to your doctor about the possible side effects of any treatment for psoriasis. They can help you understand the potential benefits and risks of any medication you might consider.

3. Reduce Inflammation in the Body

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Psoriasis is associated with other health problems, including psoriatic arthritis and heart disease. The chronic inflammation associated with psoriasis may contribute to the development of these conditions.10

Biologic treatments address systemic inflammation, so it’s possible that they may reduce the chances of developing other health conditions associated with inflammation. For example, using a systemic therapy like a biologic may reduce the risk of stroke or heart attack, according to the American Academy of Dermatology.11

Dr. Haque explained that there are still unknowns about how biologic treatment affects the development of psoriatic arthritis. Many biologics that are approved to treat psoriasis are also approved to treat psoriatic arthritis. “We know that biologics decrease systemic inflammation,” he said. “By decreasing inflammation, ideally, we’re decreasing the risk of progressing to psoriatic arthritis.”

Some study findings show that rates of psoriatic arthritis were lower in people with psoriasis who were treated with a systemic medication like biologics than those who were not.12 However, this is an area that requires more study.10 Dr. Haque said he expects future research will offer more conclusive findings about the impact of biologic use on the chances of developing psoriatic arthritis.

If you’re concerned with your current treatment, you’re not alone: In a 2022 survey of over 300 MyPsoriasisTeam members, 34 percent of those with psoriasis reported being dissatisfied with their treatment. Among the respondents with psoriasis who reported using a systemic drug, including biologics and oral drugs, 84 percent indicated they were satisfied with their treatment.13

Your dermatologist can help you decide if a systemic treatment like a biologic is the right fit for you. The International Psoriasis Council released recommendations in 2020 for determining if a person is a candidate for systemic treatments such as biologics.14 Their recommendations are summarized in the chart below. Your dermatologist may use these criteria when considering what might be an effective treatment for you.

International Psoriasis Council Systemic Therapy Criteria

You may be a candidate for systemic therapy like a biologic if:14

  1. You have psoriasis symptoms on more than 10 percent of your body.
  2. You have psoriasis on areas like your scalp, face, palms, or genitals or the soles of your feet.
  3. You have not had success with topical therapies.

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Do you think you would benefit from a systemic medication for your psoriasis? Show this article to your dermatologist to start the conversation.

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ABBV-US-01461-MC v1.0 January 2024

References
  1. Psoriatic disease and the immune system. National Psoriasis Foundation. Updated November 1, 2023. Accessed Nov. 1, 2023.
  2. Biologicals. World Health Organization. Accessed Oct. 30, 2023.
  3. Psoriasis treatment: biologics. American Academy of Dermatology. Updated June 8, 2022. Accessed Oct. 30, 2023.
  4. Oral & injected medication for psoriasis. NYU Langone Health. Accessed Oct. 30, 2023.
  5. Psoriasis treatment: corticosteroids you apply to the skin. American Academy of Dermatology. Accessed Oct. 30, 2023.
  6. Psoriasis treatment: synthetic vitamin D. American Academy of Dermatology. Accessed Nov. 1, 2023.
  7. Berry D. Fear of needles. National Psoriasis Foundation. January 27, 2022. Accessed Oct. 30, 2023.
  8. Ludmann P. Psoriasis: diagnosis and treatment. American Academy of Dermatology. Updated May 19, 2023. Accessed Nov. 1, 2023.
  9. Stringer T. Ease psoriasis symptoms with new biologic and topical treatments. Medstar Health. August 16, 2023. Accessed Oct. 30, 2023.
  10. Delzell E. Psoriatic disease affects more than skin and joints. National Psoriasis Foundation. February 3, 2021. Accessed Oct. 30, 2023.
  11. Does treating psoriasis reduce the risk of heart disease and stroke? American Academy of Dermatology. Accessed October 4, 2023.
  12. Gisondi P, Bellinato F, Maurelli M, et al. Reducing the risk of developing psoriatic arthritis in patients with psoriasis. Psoriasis (Auckl). 2022;12:213-220. doi:10.2147/PTT.S323300
  13. Schneider B, Foelsch A, Freeberg M. MyPsoriasisTeam treatment survey. MyHealthTeam; 2022.
  14. Strober B, Ryan C, van de Kerkhof P, et al; International Psoriasis Council Board Members and Councilors. Recategorization of psoriasis severity: Delphi consensus from the International Psoriasis Council. J Am Acad Dermatol. 2020;82(1):117-122. doi:10.1016/j.jaad.2019.08.026

      Posted on February 5, 2024
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      Noah Levit, M.D., Ph.D., FAAD is a board-certified dermatologist practicing in Connecticut. Learn more about him here.
      Alison Channon has nearly a decade of experience writing about chronic health conditions, mental health, and women's health. Learn more about her here.
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