Table of ContentsView AllTable of ContentsUsageHow Biologics WorkBefore TakingPrecautions/ContraindicationsDosageSide EffectsWarnings and InteractionsAre Biologics Right for You?
Table of ContentsView All
View All
Table of Contents
Usage
How Biologics Work
Before Taking
Precautions/Contraindications
Dosage
Side Effects
Warnings and Interactions
Are Biologics Right for You?
This article discusses the use of biologic treatments for psoriasis, including how to take them, side effects, interactions, and more.
Using Biologics for Psoriasis
Biologic medications for psoriasis are categorized into different classes based on whichcytokinesthey target:
According to several randomized control trials, the IL-17 inhibitor brodalumab may be more effective than other medications for improving symptoms of psoriasis, while the TNF-α inhibitor etanercept has the lowest efficacy in improving long-term outcomes.
How does biological treatment different from other psoriasis medications?Biologic treatment for psoriasis is considered the most targeted treatment for autoimmune conditions like psoriasis compared to other anti-inflammatory medications. Unlike other medications that are taken orally in pill form, biologic medication is injected under the skin or delivered intravenously into a vein.
How does biological treatment different from other psoriasis medications?
Biologic treatment for psoriasis is considered the most targeted treatment for autoimmune conditions like psoriasis compared to other anti-inflammatory medications. Unlike other medications that are taken orally in pill form, biologic medication is injected under the skin or delivered intravenously into a vein.
Getting Started: What to Know About Biologics for Psoriatic Arthritis
Biologic medications slow or stop inflammation, joint damage, and the progression ofpsoriatic disease—psoriasis and psoriatic arthritis. Both conditions are the result of an overactive immune system that affects the skin and sometimes joints throughout the body.
These cells and proteins play a major role in developing psoriasis and psoriatic arthritis.
Before taking any biologic medication, you should always have your doctor do a thorough medical examination and discuss your symptoms and medical history. Your doctor will then decide if the benefits of taking biologic medication for psoriasis outweigh the potential risks. Biologic medication is usually well tolerated with few adverse side effects.
Because biologic medication suppresses your immune system,live vaccinesthat contain live viral components are typically avoided.You may need to get certain vaccines, such as tuberculosis or hepatitis B, before starting biologic medications.
Because biologics are often expensive and more invasive than other types of medications, they are often prescribed after you have already tried other medications such as oralsteroids.
Talk to your doctor about all medications, supplements, and vitamins that you currently take. While some drugs pose minor interaction risks with biologics, others may contraindicate use or prompt careful consideration as to whether the pros of treatment outweigh the cons.
Precautions and Contraindications
Currently, etanercept is the only biologic medication approved for treating children with psoriasis who are over 6 years old. Some biologic medications, however, are being used off-label for treating psoriasis in children. TNF-α inhibitors are generally safe and effective for managing symptoms of psoriasis in pediatric patients.
Because biologic medication suppresses your immune system, it can be challenging to treat patients with psoriasis who also have chronic infections, such as hepatitis B, HIV, and latent tuberculosis, because they are already immunocompromised.
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During the acute stage of ahepatitis Binfection, patients should not be treated with biologics, although it can be initiated once the infection has resolved under close monitoring. TNF-α inhibitors may lead to reactivation of the hepatitis B virus, but IL-17 inhibitors may be a safer option when treatment is monitored closely.
For patients with HIV, biologics may be used with caution, but these patients should be closely monitored. IL-17 inhibitors for the treatment of psoriasis are generally safe for people with latent tuberculosis. However, treatment with TNF-α inhibitors can be used only after one month of preventative tuberculosis treatment has been completed.
Other Types of BiologicsBiologics refer to any type of medical treatment that is derived from living organisms. They can include a wide variety of therapeutic options such as blood platelets, hormones, vaccines, and stem cells. Generally, biologic medications for treating autoimmune conditions involve using antibodies to directly target autoimmune processes to decrease inflammation.
Other Types of Biologics
Biologics refer to any type of medical treatment that is derived from living organisms. They can include a wide variety of therapeutic options such as blood platelets, hormones, vaccines, and stem cells. Generally, biologic medications for treating autoimmune conditions involve using antibodies to directly target autoimmune processes to decrease inflammation.
The only biologic medication that is not delivered through injection is Remicade, which is delivered intravenously (IV), inserted into a vein in your arm, at a hospital or infusion center.
All listed dosages are according to the drug manufacturer. Check your prescription and talk to your doctor to make sure you are taking the right dose.
Modifications
Make sure to discuss the benefits and risks of taking biologic medication with your doctor. Certain types of biologic medications for treating psoriasis are safer and more effective in certain patient populations, including pregnant people, children, and those with compromised immune systems or chronic infections, such as HIV, tuberculosis, and hepatitis B.
How to Take and Store
Your biologic medication should be refrigerated before use. Remove your medication 30 minutes before the time that you are going to administer your injection so that the medication can reach room temperature.
Before you administer your injection, have an alcohol pad and sterile bandage ready. Wash your hands with soap and water, and swab the skin where you will administer the injection with an alcohol pad to cleanse the skin and reduce the risk of infection.
The frequency of injections depends on the specific type of medication that you are prescribed. Remicade is delivered intravenously through insertion of an IV into a vein and repeated every eight weeks.
All the other types of biologic medications are injected subcutaneously, or under the skin, most commonly in your abdomen or thigh. Some medications require a frequent injection schedule, such as Enbrel every week and Humira, Siliq, and Cimzia every other week.
Other medications require less frequent injections after the initial dose, such as Cosentyx and Taltz every four weeks, Simponi once a month, Tremfya every eight weeks, and Skyrizi and Stelara every 12 weeks.
It is important to follow your dosing regimen as missed doses can reduce the effectiveness of your biologic medication.
The most common adverse drug reactions associated with biologic injections include pain, swelling, itching, rash, and redness at the injection site. If you have any of these symptoms, talk with your doctor about the possibility of switching your medication type.
There is always a possibility of an allergic reaction when taking any type of medication. If you experience any shortness of breath, fever, chills, numbness, tingling, rash, or redness, itchiness, or pain at the injection site, contact your doctor immediately as these are possible signs of an allergic reaction.
Sometimes paradoxical reactions can occur in which psoriasis symptoms actually worsen or flare up with biologic medication, especially TNF-α inhibitors, although the symptoms are usually not severe enough to stop taking the medication.
IL-17 inhibitors have not been around for a long time, so there are less data regarding their safety, although research so far suggests that they are well tolerated with minimal side effects. IL-17 inhibitors can increase the risk of candidiasis, or yeast infection, although these infections usually are not severe enough to stop treatment with IL-17 inhibitors. Rare side effects reported with use of IL-17 inhibitors include neutropenia, low levels of the white blood cell neutrophil, and inflammatory bowel disease.
Because biologic medications decrease your immune system’s response to reduce inflammation from autoimmune reactions, it can also increase your risk of acquiring an infection or reactivating a prior infection such as hepatitis B or tuberculosis. Tuberculosis screening through skin testing, interferon (IFN)-c-release assay, chestX-ray, and chestCT(computed tomography) scan is recommended before starting biologic medications and during treatment to monitor for tuberculosis risk.
While rare, infusion reactions from infliximab can be severe and life-threatening, and can cause low blood pressure, swelling, restricted airways, and anaphylaxis, a severe allergic reaction.
You should always be under the care of a physician when taking a biologic medication and follow your dosage scheduling as prescribed.
Manufacturers warn that the biggest risk of taking biologic medications is the possibility of infection due to suppression of your immune system. Because of this, live vaccines, including thevaccines for influenzaand chickenpox, should not be administered while on biologic medication.
While research is still ongoing, there is no evidence so far that suggests biologic medications have drug-to-drug interactions with other medications.
Is Biologic Treatment Right For You?
Biologic medications are expensive, and healthcare providers will usually only prescribe them when other treatments have not worked.
Cost of Biologic MedicationsBiologic medications can range from $10,000 to $30,000 a year.Insurance companies may only cover the cost if other treatments don’t work or psoriasis is severe.
Cost of Biologic Medications
Biologic medications can range from $10,000 to $30,000 a year.Insurance companies may only cover the cost if other treatments don’t work or psoriasis is severe.
Biologics are typically prescribed based on the amount of skin affected (moderate to severe cases). However, healthcare providers will also consider a person’s quality of life when making prescription recommendations.
Certain health issues may disqualify some or all biologic drugs for the treatment of psoriasis:
Summary
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kamata M, Tada Y.Efficacy and safety of biologics for psoriasis and psoriatic arthritis and their impact on comorbidities: a literature review.Int J Mol Sci. 2020;21(5):1690. doi:10.3390/ijms21051690National Psoriasis Foundation.Current biologics on the market.National Psoriasis Foundation.Biologics.Fan R, Cohen JM.Vaccination Recommendations for Psoriasis and Atopic Dermatitis Patients on Biologic Therapy: A Practical Guide.Yale J Biol Med. 2022;95(2):249-255. Published 2022 Jun 30.Kaushik SB, Lebwohl MG.Psoriasis: which therapy for which patient: focus on special populations and chronic infections.J Am Acad Dermatol.2019;80(1):43-53. doi:10.1016/j.jaad.2018.06.056National Psoriasis Foundation.Remicade.Grace E, Goldblum O, Renda L, et al.Injection site reactions in the Federal Adverse Event Reporting System (FAERS) post-marketing database vary among biologics approved to treat moderate-to-severe psoriasis.Dermatol Ther (Heidelb). 2020;10(1):99-106. doi:10.1007/s13555-019-00341-2Ruffing N. Johns Hopkins Arthritis Center.Side effects of biologic medications.Gupta R, Levin E, Wu JJ, Koo J, Liao W.An update on drug-drug interactions with biologics for the treatment of moderate-to-severe psoriasis.J Dermatolog Treat.2014 Feb;25(1):87-9. doi: 10.3109/09546634.2013.825041Chen BK, Yang YT, Bennett CL.Why biologics and biosimilars remain so expensive: despite two wins for biosimilars, the Supreme Court’s recent rulings do not solve fundamental barriers to competition.Drugs. 2018;78(17):1777-1781. doi:10.1007/s40265-018-1009-0Thatiparthi A, Martin A, Liu J, Egeberg A, Wu JJ.Biologic Treatment Algorithms for Moderate-to-Severe Psoriasis with Comorbid Conditions and Special Populations: A Review.Am J Clin Dermatol. 2021;22(4):425-442. doi:10.1007/s40257-021-00603-w
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kamata M, Tada Y.Efficacy and safety of biologics for psoriasis and psoriatic arthritis and their impact on comorbidities: a literature review.Int J Mol Sci. 2020;21(5):1690. doi:10.3390/ijms21051690National Psoriasis Foundation.Current biologics on the market.National Psoriasis Foundation.Biologics.Fan R, Cohen JM.Vaccination Recommendations for Psoriasis and Atopic Dermatitis Patients on Biologic Therapy: A Practical Guide.Yale J Biol Med. 2022;95(2):249-255. Published 2022 Jun 30.Kaushik SB, Lebwohl MG.Psoriasis: which therapy for which patient: focus on special populations and chronic infections.J Am Acad Dermatol.2019;80(1):43-53. doi:10.1016/j.jaad.2018.06.056National Psoriasis Foundation.Remicade.Grace E, Goldblum O, Renda L, et al.Injection site reactions in the Federal Adverse Event Reporting System (FAERS) post-marketing database vary among biologics approved to treat moderate-to-severe psoriasis.Dermatol Ther (Heidelb). 2020;10(1):99-106. doi:10.1007/s13555-019-00341-2Ruffing N. Johns Hopkins Arthritis Center.Side effects of biologic medications.Gupta R, Levin E, Wu JJ, Koo J, Liao W.An update on drug-drug interactions with biologics for the treatment of moderate-to-severe psoriasis.J Dermatolog Treat.2014 Feb;25(1):87-9. doi: 10.3109/09546634.2013.825041Chen BK, Yang YT, Bennett CL.Why biologics and biosimilars remain so expensive: despite two wins for biosimilars, the Supreme Court’s recent rulings do not solve fundamental barriers to competition.Drugs. 2018;78(17):1777-1781. doi:10.1007/s40265-018-1009-0Thatiparthi A, Martin A, Liu J, Egeberg A, Wu JJ.Biologic Treatment Algorithms for Moderate-to-Severe Psoriasis with Comorbid Conditions and Special Populations: A Review.Am J Clin Dermatol. 2021;22(4):425-442. doi:10.1007/s40257-021-00603-w
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Kamata M, Tada Y.Efficacy and safety of biologics for psoriasis and psoriatic arthritis and their impact on comorbidities: a literature review.Int J Mol Sci. 2020;21(5):1690. doi:10.3390/ijms21051690National Psoriasis Foundation.Current biologics on the market.National Psoriasis Foundation.Biologics.Fan R, Cohen JM.Vaccination Recommendations for Psoriasis and Atopic Dermatitis Patients on Biologic Therapy: A Practical Guide.Yale J Biol Med. 2022;95(2):249-255. Published 2022 Jun 30.Kaushik SB, Lebwohl MG.Psoriasis: which therapy for which patient: focus on special populations and chronic infections.J Am Acad Dermatol.2019;80(1):43-53. doi:10.1016/j.jaad.2018.06.056National Psoriasis Foundation.Remicade.Grace E, Goldblum O, Renda L, et al.Injection site reactions in the Federal Adverse Event Reporting System (FAERS) post-marketing database vary among biologics approved to treat moderate-to-severe psoriasis.Dermatol Ther (Heidelb). 2020;10(1):99-106. doi:10.1007/s13555-019-00341-2Ruffing N. Johns Hopkins Arthritis Center.Side effects of biologic medications.Gupta R, Levin E, Wu JJ, Koo J, Liao W.An update on drug-drug interactions with biologics for the treatment of moderate-to-severe psoriasis.J Dermatolog Treat.2014 Feb;25(1):87-9. doi: 10.3109/09546634.2013.825041Chen BK, Yang YT, Bennett CL.Why biologics and biosimilars remain so expensive: despite two wins for biosimilars, the Supreme Court’s recent rulings do not solve fundamental barriers to competition.Drugs. 2018;78(17):1777-1781. doi:10.1007/s40265-018-1009-0Thatiparthi A, Martin A, Liu J, Egeberg A, Wu JJ.Biologic Treatment Algorithms for Moderate-to-Severe Psoriasis with Comorbid Conditions and Special Populations: A Review.Am J Clin Dermatol. 2021;22(4):425-442. doi:10.1007/s40257-021-00603-w
Kamata M, Tada Y.Efficacy and safety of biologics for psoriasis and psoriatic arthritis and their impact on comorbidities: a literature review.Int J Mol Sci. 2020;21(5):1690. doi:10.3390/ijms21051690
National Psoriasis Foundation.Current biologics on the market.
National Psoriasis Foundation.Biologics.
Fan R, Cohen JM.Vaccination Recommendations for Psoriasis and Atopic Dermatitis Patients on Biologic Therapy: A Practical Guide.Yale J Biol Med. 2022;95(2):249-255. Published 2022 Jun 30.
Kaushik SB, Lebwohl MG.Psoriasis: which therapy for which patient: focus on special populations and chronic infections.J Am Acad Dermatol.2019;80(1):43-53. doi:10.1016/j.jaad.2018.06.056
National Psoriasis Foundation.Remicade.
Grace E, Goldblum O, Renda L, et al.Injection site reactions in the Federal Adverse Event Reporting System (FAERS) post-marketing database vary among biologics approved to treat moderate-to-severe psoriasis.Dermatol Ther (Heidelb). 2020;10(1):99-106. doi:10.1007/s13555-019-00341-2
Ruffing N. Johns Hopkins Arthritis Center.Side effects of biologic medications.
Gupta R, Levin E, Wu JJ, Koo J, Liao W.An update on drug-drug interactions with biologics for the treatment of moderate-to-severe psoriasis.J Dermatolog Treat.2014 Feb;25(1):87-9. doi: 10.3109/09546634.2013.825041
Chen BK, Yang YT, Bennett CL.Why biologics and biosimilars remain so expensive: despite two wins for biosimilars, the Supreme Court’s recent rulings do not solve fundamental barriers to competition.Drugs. 2018;78(17):1777-1781. doi:10.1007/s40265-018-1009-0
Thatiparthi A, Martin A, Liu J, Egeberg A, Wu JJ.Biologic Treatment Algorithms for Moderate-to-Severe Psoriasis with Comorbid Conditions and Special Populations: A Review.Am J Clin Dermatol. 2021;22(4):425-442. doi:10.1007/s40257-021-00603-w
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