Psoriasis: When Should You Consider a Biologic?

From the WebMD Archives

When you have psoriasis, often you and your doctor will try a few treatments before finding one that really clears your skin. If you've already tried a few medicines and nothing has worked, your doctor may recommend a biologic drug.

Other drugs you may have taken are made from plants or chemicals. Biologics are made from proteins. They target the immune response that leads to the rapid skin cell growth of psoriasis.

Examples of biologic drugs include:

Biologics are potent psoriasis treatments. They work well to treat moderate or severe psoriasis, says Mark Lebwohl, MD, chairman of the National Psoriasis Foundation Medical Board, and he says he prefers them over other psoriasis drugs.

But they also have two key drawbacks:

  • Biologic drugs are expensive. Depending on the drug and the dose, they can cost $10,000 to $30,000 a year.
  • Biologics suppress the immune system. That means they can increase the risk for infection.

Here are some reasons why your doctor might -- or might not -- prescribe a biologic drug for your psoriasis.

Should You Consider a Biologic?

Whether you should consider a biologic drug depends on five factors, says Lebwohl.

  1. How much of your skin is affected
  2. How much psoriasis affects your life
  3. Your health
  4. Whether your insurance company will cover the cost
  5. Your preferences

1. How Much of Your Skin is Affected by Psoriasis

Doctors often use biologic drugs on people with moderate-to-severe psoriasis.

  • Moderate psoriasis means that 3% to 10% of your body is covered with red, scaly patches.
  • Severe psoriasis means that more than 10% of your body is covered.

You may also want to take a biologic drug if you have mild psoriasis but it really bothers you.

2. How Much Psoriasis Impacts Your Life

"One of the most important factors is how much the psoriasis actually bothers the patient. I have patients who want to start a biologic ... even if the psoriasis is in an extremely limited surface area," says Jenny Murase, MD. She's an assistant clinical professor at the University of California, San Francisco and a practicing dermatologist with the Palo Alto Medical Foundation.

Continued

You and your doctor will weigh the benefits of taking a biologic against the side effects. "Patients do have the final say in the matter, but certainly it's our job to guide them," says Lebwohl. If your psoriasis isn't really bothering you, your doctor may tell you that a biologic drug isn't worth the risks.

Your doctor may use the Koo-Menter Psoriasis Instrument to help decide your treatment. This one-page tool asks questions to find out how much psoriasis affects your life. The doctor can use your answers to find out whether you are a candidate for therapy that affects the whole body.

3. Your Health

Your doctor will take a careful look at your health history. Biologic drugs may not be best for people with certain health conditions, including:

Biologics may cause a recurrence of some chronic diseases that are in remission. Also, because biologics suppress the immune system, they could increase your risk for serious infections.

4. Insurance Coverage

Insurance companies often want doctors to try less expensive treatments first. If those treatments don't work or you have severe psoriasis, then your insurance likely will cover the cost of a biologic drug, Murase tells WebMD.

5. Your Preferences

A biologic drug is not going to help your psoriasis if you're too afraid to take it. Biologics are given by a shot or by IV infusion. People who are terrified of needles may prefer an oral drug or topical treatment instead.

How Biologics Will Affect Your Psoriasis

Whether you start with a biologic drug or turn to one after trying other therapies, you should see dramatic results. "For the most part biologics are the [drugs] that really make the difference," Murase says.

You need to follow your doctor's instructions for any treatment carefully. See your doctor for regular follow-up visits to make sure your treatment is still working. At your visits, talk about any problems or side effects you are having.

WebMD Feature Reviewed by Louise Chang, MD on August 29, 2011

Sources

SOURCES:

Mark Lebwohl, MD, dermatology department chair, Mount Sinai School of Medicine; chairman, National Psoriasis Foundation Medical Board.

Jenny Murase, MD, assistant clinical professor, University of California, San Francisco.

Bhosle, M. Health and Quality of Life Outcomes, June 2006; vol 4: p 35.

American Academy of Dermatology: "Psoriasis Treatment."

National Psoriasis Foundation: "Systemic Medications for Psoriasis and Psoriatic Arthritis," "Treating Psoriasis: Psoriasis Severity."

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