Biologic Treatments for Psoriasis

If you aren’t getting relief from other treatments, your doctor may suggest you try a drug that fights the causes of psoriasis, rather than just the symptoms. These medications, called biologics, target a specific part of your immune system.

These drugs are approved to treat moderate to severe plaque psoriasis. They also treat psoriatic arthritis, a long-term disease that comes along with the skin condition and causes painful, swollen joints.

Adalimumab (Humira). You inject it under your skin every other week. People with heart failure or multiple sclerosis shouldn't take it.

Side effects include serious and sometimes deadly infections like tuberculosis, a higher risk of certain types of cancer like lymphoma, and a greater risk of autoimmune disorders such as a lupus-like syndrome.

Adalimumab-atto (Amjevita), a biosimilar to Humira. This medicine is given as an injection, usually  every other week.

The most common side effects are infections such as tuberculosis and fungal infections, and reactions at the injection site. More serious side effects include bacterial sepsis and malignancies such as lymphoma.

Brodalumab (Siliq). Your doctor or nurse will inject this under your skin once a week initially, and then every two weeks after the first three injections. It is meant to be used by patients who have stopped responding to other systemic treatments.

The most serious side effects include suicidal tendencies. This medicine can influence your immune system and should not be taken by anyone who has had tuberculosis or suffers from Crohn’s disease.

Etanercept (Enbrel), etanercept-szzs (Erelzi). You take this by injecting it under your skin at home. You use it twice weekly for 3 months. After that, you inject it once a week.

Side effects include skin irritation and rashes. You shouldn't take it if you have multiple sclerosis, a weakened immune system, hepatitis B, or heart failure.

Infliximab (Remicade), infliximab-dyyb (Inflectra). You get this through an IV while in a doctor's office. The session lasts 2 to 3 hours. You'll follow up 2 and 6 weeks after the first dose. After that, you'll get treatments every 8 weeks.

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Ixekizumab (Taltz). This medicine is given by shot. Because this drug affects the immune system, serious allergic reactions or infections can occur. This includes the development or worsening of inflammatory bowel disease. Side effects include fungal infections, upper respiratory infections, and reactions where the shot was given.

Secukinumab (Cosentyx). This medicine is an injection given under the skin. Injections are usually given every week for the first four weeks and then every four weeks after that.

Cold symptoms, diarrhea and upper respiratory infections are some of the most common side effects. This drug also increases lowers your immune system's ability to fight infections. More serious, but rare side effects include feeling dizzy, swelling in the facial area, trouble breathing, rash and chest tightness.

Ustekinumab (Stelara). You take it by shot. After the first shot, you get another one 4 weeks later, and then one every 12 weeks.

It lessens the thickness of your psoriasis patches, while easing scaling and redness.

The drug can raise your chances of serious infections, cancer, and a rare condition called reversible posterior leukoencephalopathy, which affects your brain and is sometimes fatal.

What’s the Link Between Biologics and Infections?

Your immune system helps your body fight infections. Since biologics lower those defenses, taking them could make you more likely to get other infections and diseases.

Some of these drugs could cause a long-term disease that your body now has under control, like tuberculosis, to flare up again. Your doctor may not prescribe them if you take other medications that curb the immune system.

You could get a serious infection because your body can’t fight off fungi, bacteria, or viruses the way it usually does. Call your doctor right away if you notice any sign of an infection, like a fever, feeling run-down, a sore throat, or a cough. He may want to stop your medication for a while so your immune system has a chance to recover and help medical treatment fight the infection. Also, children and teens treated with biologics have rarely developed lymphoma and other cancers.

WebMD Medical Reference Reviewed by Stephanie S. Gardner, MD on April 20, 2017

Sources

SOURCES:

Abel, E. " Psoriasis," ACP Medicine, BC Decker, 2005.

American Academy of Dermatology.

Amgen Prescribing Information, Amjevita.

Bruce E. Strober, MD, PhD, associate professor, vice chairman, director of clinical trials, department of dermatology, University of Connecticut; consultant to Amgen, Biogen, Genentech, Fujisawa, NexGenix Pharmaceuticals Holdings Inc. and 3-M.

Coxentyx.com. 

FDA: "FDA approves new psoriasis drug Taltz."

FDA. “FDA approves Amjevita, a biosimilar to Humira.”

Jeffrey M. Weinberg, MD, Mount Sinai St. Luke's, New York; associate clinical professor of dermatology, Columbia University College of Physicians and Surgeons; consultant to Amgen and Genentech.

National Institute of Arthritis and Musculoskeletal and Skin Diseases.

National Psoriasis Foundation.

PubMed Health: “Certolizumab (Injection).”

PubMed Health: “Golimumab (Injection).”

 

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