Psoriasis treatment has come a long way in the last 20 years. There’s no cure, but medication can help you gain control of your symptoms.
If your current treatment doesn’t help enough, the doctor might suggest drugs that target certain parts of your immune system. These are called biologic or biosimilar therapies. Here’s what you need to know.
Which Biologics Help Psoriasis?
There are drugs that block certain cells or proteins that play a part in psoriasis. They change the way your immune system works. This can ease inflammation that leads to symptoms like:
- Scales
- Redness
- Burning
- Itching
- Swollen joints
Biologics fall into different groups. The name of each group comes from the immune cell or protein they target. Biologics include:
Tumor necrosis factor-alpha (TNF-alpha) inhibitors:
- Adalimumab (Humira)
- Certolizumab pegol (Cimzia)
- Etanercept (Enbrel)
- Infliximab (Remicade)
IL-17 inhibitors:
- Brodalumab (Siliq)
- Ixekizumab (Taltz)
- Secukinumab (Cosentyx)
IL-23 inhibitors:
- Guselkumab (Tremfya)
- Risankizumab-rzaa (Skyrizi)
- Tildrakizumab-asmn (Ilumya)
IL-12/23 inhibitors:
- Ustekinumab (Stelara)
What Are Biosimilars?
Like the name suggests, these drugs are similar to biologic drugs. They’re usually a lot cheaper, too. You can think of them like the generic version, but they’re not exactly the same. That’s because both biosimilars and biologics are made from living organisms. But unlike chemical medications, it’s hard to make a true copy from organic material.
Your doctor isn’t likely to pick a biosimilar over a biologic as a first choice for your psoriasis. But your health insurer might want you to try a biosimilar first since they’re less expensive.
Sometimes a pharmacist may swap your biologic for a biosimilar without checking with your doctor first. Tell your doctor if this happens to you. They’ll let you know if it’s OK to take the biosimilar choice. Studies show biosimilars are safe and should work just as well as their biologic counterparts.
How Fast Do Biologics Work?
Everyone’s immune system reacts differently. Some people start to see clearer skin within 2 to 4 weeks. In general, you should expect to see some improvement within at least 8 weeks.
If you don’t get any better in a couple of months, your doctor will probably switch you to a different biologic.
There are a few factors that affect how fast a biologic might clear your skin or ease other symptoms like burning or itching. For example, you might respond quicker if you’ve never tried one of these drugs before. Or it might take longer to see results if you’ve switched drugs because another biologic stopped helping your psoriasis.
It also depends on which type of biologic you’re taking. Il-17 and Il-23 agents, called second-generation drugs, are newer than TNF-alpha inhibitors (first-generation drugs) and they tend to work faster. On average, your skin might get 50% better within the first month on a second-generation drug.
There’s evidence that drugs that block IL-17 and IL-23 might be more effective for psoriasis than older biologics. But your doctor may still suggest a TNF-alpha inhibitor in certain cases, such as if you also have psoriatic arthritis.
No matter which biologic or biosimilar you’re on, you should see peak results within 24 weeks.
How Do You Know If Biologics Work?
These drugs can completely clear skin for a lot of people. But success is based a lot on your goals and symptoms. For instance, you might feel really good if your burning and itching goes away, but you still have psoriasis on 1% to 2% of your body.
Your doctor has some medical guidelines they can go by to gauge your biologic’s success. They’ll measure how much psoriasis covers your body surface area (BSA). You should have 3% or less BSA after 3 months of treatment and less than 1% within 6 months.
Compared to other psoriasis treatments, people who take biologics tend to be happier with their results. Be sure to tell your doctor which symptoms bother you most. That’ll give them a better idea of whether a drug is working the way you need it to.
Tell them if you have psoriasis on specific areas, including your:
- Scalp
- Palms
- Soles
- Genitals
Your doctor may also pick a biologic based on other health issues if you have them. Some are better for treating psoriasis along with conditions like:
- Psoriatic arthritis
- Ankylosing spondylitis
- Non-radiographic axial spondyloarthritis
Often, your health insurer plays a big role in which medication you can take. That’s because they may only agree to pay for a certain kind of biologic. But your psoriasis has a good chance of getting better no matter which class you start with.
Can You Use Combination Therapy?
You might gain better control of your psoriasis when you pair a biologic or biosimilar with another psoriasis treatment. Common choices include phototherapy or oral drugs like acitretin, cyclosporine, and methotrexate.
More research is needed to know which combination therapies work best for psoriasis. In the meantime, your doctor can help you find the right mix of treatments.
Talk to Your Doctor
Biologics can clear your skin for a long time. But they may not work as well over time. You might need to switch to a different kind at some point, so tell your doctor if your scales, burning, or itching return.
Schedule routine checkups with your regular doctor. Psoriasis can happen alongside other health issues, including high cholesterol, high blood pressure, insulin resistance, and depression. You’ll feel your best when you get good treatment for all of your medical conditions.
Show Sources
Photo Credit: maxuser / Getty Images
SOURCES:
Keith Choate, MD, PhD, professor of dermatology, pathology, and genetics, Yale School of Medicine.
Biologics: Targets and Therapy: “Biologic Treatments of Psoriasis: An Update for the Clinician.”
National Psoriasis Foundation: “Biologics.”
UpToDate: “Treatment of psoriasis in adults.”
International Journal of Molecular Sciences: “Old and New Biological Therapies for Psoriasis.”
Cochrane Database of Systematic Reviews: “Systemic pharmacological treatments or chronic plaque psoriasis: a network meta-analysis.”
Dermatology and Therapy: “Clinical Goals and Barriers to Effective Psoriasis Care.”
Jama Dermatology: “Combining Biologic Therapies With Other Systemic Treatments in Psoriasis Evidence-Based, Best-Practice Recommendations From the Medical Board of the National Psoriasis Foundation.”
Biologic and Systemic Agents in Dermatology: “Combination Therapy with Biologics and Other Systemic Treatments in Psoriasis.”
