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Biologics for Psoriasis: What to Consider

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Psoriasis is a common chronic immune disease that causes skin cells to grow quickly. The fast growth can lead to scaly, itchy, dry, and red skin patches. More than 7.5 million people in the United States have psoriasis.

There are several treatment options for psoriasis, including topical treatments, prescription drugs, and phototherapy. If you have moderate to severe psoriasis and your current treatment isn't working, it may be time to think about a biologic.

Keep reading to find out more about this newer class of drugs.

Why are biologics a good option for psoriasis treatment?

Biologics are target-specific drugs that act by blocking certain inflammatory cytokines. Unlike other drugs that are derived from plants or chemicals, biologics are made from sugars, proteins, or nucleic acids. They may also be made from human, animal, or microorganism cells and tissues.

Biologics are considered to be both safe and effective.

How do biologics work?

Biologics used to treat psoriasis work by blocking certain inflammatory cytokines produced by specific pathways that cause psoriasis. Biologics target cytokines produced by two main pathways: Th1 and TH17.

Th1 mechanism

Some biologics target cytokines produced by T-helper cells (T-cells), which are involved in psoriasis. Th1 cells, types of T-cells, increase inflammatory cytokines that cause psoriasis, including interferon-gamma (IFN-?), tumor necrosis factor-alpha (TNF-a) and interleukin-12 (IL-12).

Th17 mechanism

Some biologics target cytokines produced by Th17 cells, which can also cause psoriasis. These cells stimulate secretion of IL-17 cytokines. Biologics can stop these inflammatory cells and reduce the onset of psoriatic arthritis.

What biologics are currently available?

Currently, there are seven biologics for psoriasis:

  • infliximab (Remicade)
  • adalimumab (Humira)
  • etanercept (Enbrel)
  • ustekinumab (Stelara)
  • apremilast (Otezla)
  • ixekizumab (Taltz)
  • secukinumab (Cosentyx)

These biologics target different cytokines and inflammatory mediators, so talk to your doctor about which biologic is right for you. Research to develop other biologics for psoriasis is ongoing.

Can biologics be combined with other treatments?

The use of a single drug or a single therapeutic method may not be effective for everyone with psoriasis. If single drugs aren't working for you, it may be time to consider combining biologics with traditional treatments.

There are three main benefits of using a combination approach:

  • It can decrease the possibility of reaching toxic levels with a single drug.
  • The single drug will be prescribed at a lower dose.
  • A combination approach can be more successful than a single dose.

Research shows that those taking a biologic, or a biologic along with another form of treatment, are generally more satisfied than those taking topical therapies or acitrecin (Soriatane) alone.

If you feel like your current psoriasis treatment isn't working, talk to your doctor about biologics. Using biologics, or a combination of biologics with traditional drugs, may be the answer for you.

Written by Jennifer Abayowa

Medically Reviewed by Darren Hein, PharmD on July 5, 2016

Read more in Psoriasis Resources
  • Psoriasis. (2015). Retrieved from https://www.aad.org/media-resources/stats-and-facts/conditions/psoriasis
  • Cai, Y., Fleming, C., & Yan, J. (2012). New insights of T cells in the pathogenesis of psoriasis. Cellular & Molecular Immunology, 9(4), 302ñ309. Retrieved from http://www.nature.com/cmi/journal/v9/n4/full/cmi201215a.html
  • Callis Duffin, K., Yeung, H., Takeshita, J., Krueger, G. G., Robertson, A. D., Troxel, A. B., Ö Gelfand, J. M. (2014, March). Patient satisfaction with treatments for moderate-to-severe plaque psoriasis in clinical practice. British Journal of Dermatology, 170(3), 672ñ680. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/bjd.12745/abstract 
  • Lewis, B. J., Rajpara, S., Haggart, A. M., Wilson, H. M., Barker, R. N., & Ormerod, A. D. (2013, July). Predominance of activated, clonally expanded T helper type 17 cells within the CD4+T cell population in psoriatic lesions. Clinical & Experimental Immunology, 173(1), 38ñ46. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/cei.12086/abstract
  • * Mease, P. J., McInnes, I. B., Kirkham, B., Kavanaugh, A., Rahman, P., van der Heijde, D., Ö Mpofu, S. (2015). Secukinumab inhibition of interleukin-17A in patients with psoriatic arthritis. New England Journal of Medicine, 373(14), 1329ñ1339. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMoa1412679
  • Noda, S., Krueger, J. G., & Guttman-Yassky, E. (2014, November 17). The translational revolution and use of biologics in patients with inflammatory skin diseases. Journal of Allergy and Clinical Immunology, 135(2), 324ñ336. Retrieved from http://www.jacionline.org/article/S0091-6749(14)01669-8/abstract
  • Feely, M.A., Smith, B.L., & Weinberg, J.M. (2015, May). Novel psoriasis therapies and patient outcomes, part 2: biologic treatments?: cutis: cutaneous medicine for the practitioner. Cutis, 95(5), 282-290. Retrieved from http://www.cutis.com/the-publication/past-issues-single-view/novel-psoriasis-therapies-and-patient-outcomes-part-2-biologic-treatments/98d6e144e5a4d6d1be15f9de4efa53fd.html
  • Papoutsaki, M. & Antoniou, C. (2015). Biologic agents for psoriasis. European Handbook of Dermatological Treatments, 1411ñ1420. Retrieved from http://link.springer.com/chapter/10.1007%2F978-3-662-45139-7_137
  • Pariser D.M., Bagel J., Gelfand J.M., Korman, N.J., Ritchlin, C.T., Strober, B.E., Ö Van Voorhees, A.S. (2007, February). National psoriasis foundation clinical consensus on disease severity. Archives of Dermatology, 143(2), 239ñ242. Retrieved from http://archderm.jamanetwork.com/article.aspx?articleid=411159
  • Rachakonda, T. D., Schupp, C. W., & Armstrong, A. W. (2014, January 6). Psoriasis prevalence among adults in the United States. Journal of the American Academy of Dermatology, 70(3), 512ñ516. Retrieved from http://www.jaad.org/article/S0190-9622(13)01268-1/abstract
  • What is a biological product? (2015, August 20). Retrieved from http://www.fda.gov/AboutFDA/Transparency/Basics/ucm194516.htm

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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.