The last decade has seen some promising advances in the treatment of psoriasis. Systemic medications called biologics -- because they are made from living organisms -- may offer hope to people who haven't had success with other approaches or who are concerned about the toxicity of other medicines.
The shift in treatment has grown from a new understanding of the condition's basic cause. Many treatments for psoriasis -- such as topical creams and phototherapy -- treat the symptoms of the disease and reduce the effects of flare-ups. But biologic treatment targets the root cause. It either directly or indirectly blocks the effects of the T-cells, the immunological agents that cause the inflammation of psoriasis.
Drugs like methotrexate and cyclosporine also affect the immune system, but they are far more likely to cause serious side effects. New biologic drugs are apparently more focused in their effects.
Biologic therapy is a fairly new approach. So far, only these biologics drugs have been approved by the FDA for the treatment of psoriasis: Enbrel, Humira, Stelara, and Remicade. As with any drugs that suppress the immune system, biologic therapy could make your body more vulnerable to other infections and diseases. Some biologics may also cause some chronic diseases in remission -- such as tuberculosis -- to flare up. Biological medications may not be prescribed to a person who takes other medications that also suppress the immune system.
One disadvantage to biologic medication is that it has to be given either by injection or by intravenous infusion. Infusion can take two hours per session. Still, many doctors say these new drugs can more effectively treat psoriasis with fewer side effects. Here's a rundown of the biologic medications used for moderate to severe psoriasis.
- Enbrel was previously used as a treatment for psoriatic arthritis, but it is also approved for psoriasis.It is also approved for treating rheumatoid arthritis, juvenile rheumatoid arthritis, and ankylosing spondylitis (arthritis affecting the spine). Patients can inject Enbrel under their skin at home. You would use it twice weekly for three months. After that, you would inject it once a week. Side effects include skin irritation and rashes. It should not be used in people with multiple sclerosis and heart failure.
- Remicade is approved for the treatment of severe plaque psoriasis. It is also approved for treating rheumatoid arthritis, ankylosing spondylitis (arthritis affecting the spine), and Crohn's disease and ulcerative colitis (inflammatory bowel conditions). Patients receive Remicade as an infusion in a doctor's office. This treatment is given over a two- to three-hour period. Patients receive an additional infusion both two and six weeks after the first infusion and then every eight weeks. Tuberculosis, invasive fungal infections, and other serious infections have been reported in Remicade patients; some of the infections have been fatal. People taking Remicade should be monitored for signs of infection, and if a serious infection develops, the medication should be stopped.
- Humira is also approved for the treatment of severe plaque psoriasis and rheumatoid arthritis. Patients can injection this medication under the skin every other week. People with heart failure or multiple sclerosis should not take this medication. Humira's side effects include serious and even fatal infections such as tuberculosis, an increased risk of certain types of cancer such as lymphoma, and an increased risk of autoimmune disorders such as a lupus-like syndrome.
- Stelara is approved to treat moderate to severe psoriasis that involves large areas or many areas of the body. It improves plaque thickness, scaling, and redness. Stelara can increase your chances of serious infections, cancer, and a rare condition called reversible posterior leukoencephalopathy, which affects the brain and can cause death. Stelara is given by injection. After the first shot, patients get another shot four weeks later, and then a shot every 12 weeks.
Biologics are currently more expensive than conventional systemic treatments. However, the evidence suggests that they work well and pose fewer risks than other systemic therapies.