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 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.

Apremilast (Otezla). This isn’t a biologic, but it does affect your immune system. It’s a pill that you take once or twice a day. It reduces the redness, thickness, and scaliness of psoriasis plaques.

It has been linked to depression and suicidal thoughts or behavior. Tell your doctor if you've ever had these kinds of thoughts or feelings before you start this medication.

You might also have diarrhea, nausea, an upper respiratory tract infection, headaches, and other side effects. You could lose weight without trying, so your doctor will keep track of how much you weigh.

Etanercept (Enbrel). 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). 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.

Ixekizumab (Taltz). This medicine is given by injection. 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 injection site reactions.

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

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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 like it usually does. Call your doctor right away if you notice any sign of an infection, like a fever, feeling rundown, 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 developed lymphoma and other cancers.

WebMD Medical Reference Reviewed by Stephanie S. Gardner, MD on July 19, 2016

Sources

SOURCES:

American Academy of Dermatology.

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

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

FDA. "FDA approves new psoriasis drug Taltz."

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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