A Guide to Biologic Medications for Psoriasis

If you’re living with psoriasis or psoriatic arthritis, you’re probably used to some amount of trial and error to find what works. Certain treatments are really effective for some people—but not so much for others. If topical treatments like steroid ointments or vitamin E analogues don’t work, your doctor may suggest biologics (short for biological medicines). Here’s what you need to know about this relatively new psoriatic treatment if you’re considering it.

First of All, What Are Biologics?

By definition, biologic drugs are made from living cells, rather than being chemically synthesized or pharmacological like some other medications, such as aspirin (Bayer), ibuprofen (Advil, Motrin) or acetaminophen (Tylenol). Biologics bind to chemical messengers that cause inflammation, says board-certified dermatologist Todd Minars, M.D., of Minars Dermatology in Hollywood, Florida. Unlike some psoriasis drugs that work on your whole immune system, biologics only work on the parts that cause the overgrowth of skin cells.

“Biologics help patients with a variety of inflammatory skin diseases. The one they help the most is psoriasis, which is great, as it tends to be a problematic condition for many patients,” Minars says. “They specifically work by targeting and down-regulating some of the inflammatory pathways that seem to be ‘overactive’ in psoriasis patients.”

The first biologic to be FDA-approved for psoriasis was alefacept (Amavive), in 2003. Nowadays, there are several options, including Cimzia, Cosentyx, Enbrel, Humira, Remicade, Stelara, and Skyrizi.

Who Are Biologics Recommended For?

While biologics can be highly effective, they are not usually first-line treatments, says board-certified dermatologist Rhonda Klein, M.D., of Modern Dermatology of Connecticut in Westport. In moderate to severe cases of psoriasis or psoriatic arthritis, biologics may be prescribed if the patient has already tried topicals, systemic oral medications, and lifestyle changes without experiencing an improvement.

By and large, biologics are considered safe—but they aren’t suitable for everyone. “They work by calming down part of the immune system, so with this suppression, anyone taking a biologic has an increased risk of developing a serious infection,” Klein says. “The risk is higher in patients who have other immune-system compromises, such as diabetes or older age. People who smoke are also at higher risk.”

Someone with cancer or an underlying chronic infection like tuberculosis might not be a candidate for biologics, Minars adds. As with any new medication or treatment option, it’s important to tell your dermatologist about any other health conditions you have, to ensure you get the best course of treatment.

How Do You Take Biologics?

Biologics are available only by prescription from a board-certified dermatologist. They may be taken as an IV infusion or as a shot, and the frequency varies depending on the medication and your circumstances.

For example, some biologics are taken via self-injection twice weekly, and others are injected at a doctor’s office as few as four times per year.

“Depending on your circumstances, your dermatologist will recommend your medication based on what is most likely to help your condition and what can work with your schedule and tolerances—some people don't want to inject themselves,” says Minars.

How Much Improvement Is Expected?

According to Minars, biologics are much more effective than traditional pharmacological drugs in treating psoriasis. “Some biological drugs, like Stelara, can achieve amazing results with only four injections per year,” he says. “Many patients with terrible psoriasis can achieve clear or almost clear skin only a short time after a biologic’s regular routine is established.”

The downside is that biological drugs are very expensive. “They can easily cost the patient tens of thousands of dollars per year,” Minars says. “So there's a lot that a patient has to factor into their decision, but I can say that biologics offer amazing improvement for those with psoriasis.”

Are There Any Potential Side Effects to Be Aware Of?

As well as being more effective than pharmacological medications, biologics are considered to be safer, with few side effects.

“There is no such thing as a ‘no-risk’ treatment,” Minars says. “But I consider biologics to be ‘low-risk’ treatments.”

The reason why is because a biological drug often targets a precise branch of an inflammatory pathway. Because hundreds of these pathways make up the immune system, people on biologics aren’t considered immunosuppressed. However, Minars notes that if you look at large enough populations of patients on these medications, there may be small increases in rates of some infections and cancers.

“Each biologic drug is different and has its own safety profile, which is why these are not over-the-counter, and you need to work with your dermatologist,” Minars says. “It is also complicated to study because infection increases are generally small and therefore hard to detect.” He also notes that it’s hard for researchers to tell whether those problems are more likely because of the medication, because of having psoriasis in general, or because of immunosuppressive drugs a person may have taken in the past.

So, while increases in some infections can occur, they needn’t be a major concern, so long as you’re transparent with your dermatologist about your health history, medications, and treatments.

Can Biologics Be a Long-Term Treatment for Psoriatic Disease?

Biologics can be used indefinitely to treat psoriasis and psoriatic arthritis, but some patients may stop responding to their particular medication after several years and need to change drugs, Klein says. Luckily, there are several options on the market with different targets.

“Patients respond best with continual use of biologics versus starting and stopping,” Klein says. If you only use a biologic intermittently, you could potentially develop a rapid, short-term onset of drug intolerance called tachyphylaxis that could interfere with its effectiveness. So, talk to your doctor to see if a biologic might be right for you; and, if it is, take it as directed.