Starting a biologic drug for psoriasis involves a screening process that considers your medical history and current health. Biologics can be highly effective in treating moderate to severe psoriasis. But your doctor will need to assess risk factors before you start biologic therapy.

Biologic drugs work by suppressing overactive proteins in your immune system. These proteins cause flare-ups and the overproduction of skin cells. Your doctor may consider biologic therapy when other treatments haven’t been effective or have caused adverse effects. These other treatments may include topical treatments, corticosteroids, and phototherapy. Biologics may also be used in combination with other treatments 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?”

“The biologics changed my life and I would never have been as functional as I am today without them.”

— A MyPsoriasisTeam member

“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

Several tests are needed before starting a biologic drug. These tests help determine if you have an underlying — or silent — infection. Biologic medications increase the risk for infection. Therefore, an existing infection will usually need to be treated before starting a biologic drug. Screenings are done on an individual basis. Your healthcare provider will assess which tests are right for your health history, diagnosis, and treatment.

Tests that may be 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

You’ll also need vaccination counseling before you start a biologic. Because biologics suppress the immune system, you’ll want to make sure you’re immunized against common infections like the flu and COVID-19. Your doctor will check to make sure you’re up-to-date on your shots and determine if you need any new ones. It is not recommended to take live vaccines while on biologic medications.

Biologics increase the risk for infection, so an existing infection will usually need to be treated before starting a biologic drug.

Additional blood tests may be conducted to determine baseline indicators to monitor while you’re on a biologic. The decision for your doctor to perform these tests may depend on other medical problems you may have or are at risk of developing.

Here are some common baseline tests:

• A liver enzyme test measures liver function. This 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. This is monitored 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 antibody (ANA) test can indicate other autoimmune diseases, such as lupus. This test may be offered when taking a biologic.
• A human immunodeficiency virus (HIV) blood test is recommended. This is not only to check for latent HIV infection, but also due to the impact of biologic drugs on immune system T cells, which may affect treatment for HIV or AIDS.

Medication Administration, Doses, and Schedules

A number of biologic drugs are used to treat psoriasis. There are a range of ways the drugs are taken, dosed, and scheduled. Ask your dermatologist and healthcare team about the details of the biologics that are part of your psoriasis treatment plan.

Biologics that have been used to treat psoriasis include a class of drugs called tumor necrosis factor-alpha (TNF-alpha) inhibitors. TNF-alpha inhibitors target particular inflammatory proteins in the immune system. Newer biologic drugs target interleukin proteins in the immune system, including interleukin (IL)-12, IL-23, and IL-17.

Biologic Drug Administration

Biologic drugs are taken by infusion or injection. That’s because they consist of large molecule compounds that can’t be effectively absorbed in the digestive system if taken orally. Infusions of biologics are administered into the blood through an IV (intravenous) line. This is done in a clinical setting, like a doctor’s office or infusion center.

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

Dosage of Biologic Drugs

Dosage for biologic drugs often changes over time. “Loading dose” is a clinical term that describes using an increased dose initially to more quickly reach a steady state of drug concentration in the body. For this reason, and for faster therapeutic results, biologics are often administered in higher doses when starting treatment. Dosage may then be tapered down over time to what is known as the “maintenance dose.” Loading doses vary between medications.

Depending on the biologic drug you’re taking, you may have some choices in your treatment schedule.

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. You may 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’re taking, you may have some choices in your treatment schedule.

Discuss treatment scheduling with your doctors. It’s important to adhere to the schedule required for the specific biologic drug you’re taking.

Common Side Effects

Biologic drugs can increase the risk for infection. This is because they suppress parts of the immune system. Along with a risk for infection, other common side effects for biologic drugs include injection site reactions or allergic reactions such as shortness of breath or itchiness. Any indication of a serious infection should be reported immediately to your dermatologist and healthcare team. These may include:

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

Less common side effects can include central nervous system symptoms, such as tingling, or cardiac symptoms, such as worsening of heart failure.

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. But it varies based on the protein that’s being targeted by the drug. An analysis of 45 clinical trials showed results in six to eight weeks for people taking IL-17 inhibitors. The average response times in this analysis for IL-23 inhibitors was between nine and 10 weeks. People who took IL-12/IL-23 inhibitors saw results between 11 and 12 weeks. 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.”

Join the Conversation

On MyPsoriasisTeam, people come together to share their experiences with psoriasis, get advice, and find support from others who understand.

Are you living with psoriasis and considering biologic treatment? Let others know in the comments below.