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Starting a Biologic for Psoriasis: What To Expect

Posted on May 03, 2021
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Joan Grossman

  • Before starting a biologic drug, you will be screened for infections and baseline monitoring.
  • Biologic drugs are taken by injection or IV infusion, and some can be self-injected.
  • Doses are often decreased over time.
  • Biologic drugs typically take between 10 and 14 weeks to start working.

Starting a biologic drug for psoriasis involves a screening process that considers your medical history and current health condition. Biologics can be highly effective in the treatment of moderate to severe psoriasis, but risk factors need to be assessed before starting biologic therapy.

Biologic drugs work by suppressing overactive proteins in the immune system that cause flare-ups and the overproduction of skin cells. Biologic therapy is considered when topical treatments, corticosteroids, and other treatments such as phototherapy have not been effective. Biologics may also be a treatment option in combination with other therapies or to replace another systemic therapy like cyclosporine.

MyPsoriasisTeam members often ask questions about starting a biologic drug. “I just got home from the dermatologist and I’m going to be starting a biologic for the first time after blood work is confirmed,” a member wrote. “Any suggestions for someone who’s never used medications like that?”

“I’m starting the new med today! Anyone have any input on their favorite time of day to take a biologic?” asked another member.

Common Screening Tests

A number of tests are needed before starting a biologic drug to determine if you have an underlying — or silent — infection. Biologic medications increase the risk for infection, and an existing infection will usually need to be treated prior to starting a biologic drug. Tests that are typically administered to detect silent infections include:

  • Tuberculosis (TB) blood test, and possibly a chest X-ray and skin test to determine if you have a latent TB infection
  • Hepatitis B and hepatitis C blood tests

Additional blood tests are conducted to determine baseline indicators that will be monitored while you’re on a biologic. Here are some common baseline tests:

  • A liver enzyme test measures liver function, which is monitored when taking biologic or immunosuppressive drugs like methotrexate.
  • A complete blood count measures red blood cells, white blood cells, hemoglobin, hematocrit, and platelets to monitor for abnormal blood counts (a risk with biologics).
  • Lipids (blood fats, such as cholesterol) are monitored because people with psoriasis have an increased risk for cardiovascular disease.
  • An antinuclear antibodies (ANA) test can indicate other autoimmune conditions, such as lupus, and may be offered when taking a biologic.
  • A human immunodeficiency virus (HIV) blood test is recommended because of the impact of biologic drugs on immune system T cells, which may affect treatment for HIV/AIDS.

Medication Administration, Doses, and Schedules

A number of biologic drugs are used to treat psoriasis, and there are a range of ways the drugs are taken, dosed, and scheduled. Ask your dermatologist and health care team about the particular usage of biologic drugs that are recommended for you.

Biologics typically used to treat psoriasis include a class of drugs called tumor necrosis factor-alpha (TNF-alpha) inhibitors that target particular inflammatory proteins in the immune system. Examples include:

Other biologic drugs target interleukin proteins in the immune system, including IL-12, IL-23, and IL-17. Interleukin inhibitors include:

Orencia (abatacept) is a biologic drug that targets T cells in the immune system.

Biologic Drug Administration

Biologic drugs are taken by infusion or injection because they consist of large molecule compounds that cannot be effectively absorbed in the digestive system if taken orally. Infusions of biologics are administered into the blood through an IV and require a clinical setting.

Biologic injections are administered by syringes or auto-injector pens that release the drug subcutaneously, or under the skin. Some biologics can be self-injected at home.

Read more about self-injection.

Dosage of Biologic Drugs

Dosage for biologic drugs often changes over time. “Loading dose” is a clinical term that refers to using an increased dose to more rapidly reach a steady state of concentration of medication in the body. To achieve a steady concentration of biologic drugs and faster therapeutic results, biologics are often administered in higher doses at the start of treatment. Dosage may then be tapered down over time. Loading doses vary between medications.

Schedules for Taking Biologics

Biologic drugs are prescribed on a wide range of schedules. You may be prescribed higher doses weekly at the onset of treatment and then taper off to one treatment every four weeks or eight weeks. Some drugs are reduced to a schedule of once every 12 weeks. Depending on the biologic drug you are taking, you may have some choices in your treatment schedule.

Discuss the scheduling of your treatment carefully with your doctors. It is important to adhere to the schedule required for the specific biologic drug you are taking.

Common Side Effects

Biologic drugs can increase the risk for infection because they suppress parts of the immune system. Along with a risk for infection, other common side effects for biologic drugs include reactions at the injection site, headache, and nausea. Any indication of a serious infection should be reported immediately to your dermatologist and health care team. These may include:

  • Fever or chills
  • Muscle pain or tingling
  • Rash or painful sores
  • Diarrhea or abdominal pain
  • Abnormal urination

Talk to your doctors about any side effects you experience and get medical advice about how best to manage them. MyPsoriasisTeam members frequently share their experiences with side effects. “Just finished the loading dose almost two weeks ago. I’m having very good results,” said a member. “The only side effect I've seen is fatigue, but that could be the disease.”

Another member wrote, “The biologics changed my life and I would never have been as functional as I am today without them. The biggest side effect I find is infection. I tend to get bronchitis and pneumonia a few times every year (winter). But otherwise, I tolerate the meds quite well.”

How Quickly Do Biologics Work?

Biologic drugs can take time to start working. Some people with psoriasis may experience relief of symptoms within a month, but more commonly biologic drugs take 10 to 14 weeks for an initial response. With biologic drugs, it’s important to maintain your treatment plan and try to be patient as the drug takes effect.

MyPsoriasisTeam members have shared questions and experiences while waiting for biologic drugs to start working. “It’s almost time for my fourth biweekly injection. So I’ve been on it almost six weeks. How long does it take to work? Improvement in my psoriasis, but not a lot,” a member wrote.

Another member responded. “It takes a while. You just have to stick with it or talk to your doctor about adding [another treatment] with the biologic. It's my fourth month on it and [my psoriasis] is much better than it was. Good luck!”

One member had earlier results: “I started three months ago and amazingly my psoriasis started to clear almost straight away.”

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 91,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Are you living with psoriasis and considering biologic treatment? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References

  1. 9 Medical Tests You Need Before Starting a Biologic Drug — CreakyJoints
  2. Use of Biologic Agents in Combination With Other Therapies for the Treatment of Psoriasis — American Journal of Clinical Dermatology
  3. Complete Blood Count (CBC) — Mayo Clinic
  4. Psoriasis and Cardiovascular Diseases: A Literature Review To Determine the Causal Relationship — Cureus
  5. A Practical Approach to Screening Psoriasis Patients for Therapy with Biologic Agents — The Journal of Clinical and Aesthetic Dermatology
  6. Management of Psoriatic Patients in Biologic Treatment Associated With Infectious Comorbidities — Advances in Dermatology and Allergology
  7. Patient Experience With Intravenous Biologic Therapies for Ankylosing Spondylitis, Crohn’s Disease, Psoriatic Arthritis, Psoriasis, Rheumatoid Arthritis, and Ulcerative Colitis — Patient Preference and Adherence
  8. Biologics — National Psoriasis Foundation
  9. Recent Advances in the Oral Delivery of Biologics — The Pharmaceutical Journal
  10. Dose Adjustment of Biologic Therapies for Psoriasis in Dermatological Practice: A Retrospective Study — Journal of the European Academy of Dermatology and Venerology
  11. Ten Common Questions (and Their Answers) About Off-label Drug Use — Mayo Clinic Proceedings
  12. The Pharmacological and Clinical Aspects Behind Dose Loading of Biological Disease Modifying Anti-rheumatic Drugs (bDMARDS) in Auto-immune Rheumatic Diseases (AIRDs): Rationale and Systematic Narrative Review of Clinical Evidence — BMC Rheumatology
  13. Joint AAD-NPF Guidelines of Care for the Management and Treatment of Psoriasis With Biologics — Journal of the American Academy of Dermatology
  14. Side Effects of Biologic Medications — Johns Hopkins Arthritis Center
  15. Debunking Psoriasis Myths: How Long Do Patients Have To Wait to See Results With Biologics? — MDedge
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.
Joan Grossman is a freelance writer, filmmaker, and consultant based in Brooklyn, NY. Learn more about her here.

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