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.

Researchers are always testing new biologics, and new ones may get approved down the road. Biologics that are now available to treat both plaque psoriasis and psoriatic arthritis are:

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 chance of having certain types of cancer like lymphoma, and a greater risk of autoimmune disorders such as a lupus-like syndrome.

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.

Secukinumab ( Cosentyx). This is a medicine that you inject under your skin with a prefilled syringe or a pen. You can do this at home, but you should get training first on how to do it from your doctor.

The most common side effects are:

  • Symptoms of a cold
  • Upper respiratory infection
  • Diarrhea

There's also a chance of serious infections when you take secukinumab. Your doctor will check to make sure you don't have tuberculosis (TB) before you start treatment and will watch you closely for signs of the disease while you're using the medicine.

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.

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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.

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 cuts 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.

Biologics that are approved for plaque psoriasis are:

Brodalumab (Siliq). This medicine comes as a prefilled syringe that gets injected under your skin. Your doctor generally gives you the shot in his office, but he may decide to let you do this at home if he trains you on how to do it.

The medicine's label has an FDA warning that that some people who take brodalumab may have a greater chance of having thoughts and actions of suicide. So the FDA suggests doctors weigh the risks and benefits of the medicine before suggesting it for people who have had depression or suicidal thoughts in the past.

The drug also has a risk of infections.

Ixekizumab (Taltz). This is a drug that you take as a shot. You do it yourself at home once your doctor shows you how.

The most common side effects include:

  • Reaction at the place you injected the drug
  • Upper respiratory infections
  • Nausea
  • Fungal infections

There's also a risk of serious infections like tuberculosis (TB), so your doctor will check you for TB before you take ixekizumab and watch you for signs of the disease while you use the medicine.

Biologics that treat psoriatic arthritis are:

Certolizumab (Cimzia). You start by getting a shot at the doctor's office. They may teach you how to do it at home. You'll take it every other week.

This drug makes you more likely to get infections and can lead to forms of cancer, heart failure, and a lupus-like syndrome. You may bruise or bleed more easily.

Golimumab (Simponi). You take this by giving yourself a shot once a month. It can lead to a greater chance of having an infection, lymphoma and other cancers, heart failure, and liver problems. You might bruise or bleed more easily.

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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 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 he can treat the infection. Also, children and teens treated with biologics have developed lymphoma and other cancers.

WebMD Medical Reference Reviewed by Debra Jaliman, MD on May 24, 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 3M.

Coxentyx.com. 

FDA: "FDA approves new psoriasis drug Taltz," “FDA approves Amjevita, a biosimilar to Humira,” "Cosentyx Medication Guide," "FDA approves new psoriasis drug," "Taltz Medication Guide."

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),” “Golimumab (Injection).”

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