Moderate to Severe Psoriasis: Biologic Drugs
Biologic drugs, or "biologics," are given by injection or intravenous (IV) infusion. A biologic is a protein-based drug derived from living cells cultured in a laboratory. While biologics have been used to treat disease for more than 100 years, the advent of modern day molecular biologic techniques has accelerated their use in modern day medicine tremendously in the last decade.
Different from the traditional systemic drugs that impact the entire immune system, biologics target specific parts of the immune system. The biologics used to treat psoriatic disease act by blocking the action of a specific type of immune cell called a T cell, or by blocking proteins in the immune system, such as tumor necrosis factor-alpha (TNF-alpha) or interleukins 12 and 23. These cells and proteins all play a major role in developing psoriasis and psoriatic arthritis.
The National Psoriasis Foundation Medical Board has issued a statement on biosimilar substitution. Read the statement »
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Tumor necrosis factor-alpha (TNF-alpha) blockers
Enbrel (etanercept), Humira (adalimumab), Remicade (infliximab) and Simponi (golimumab) are drugs that block TNF-alpha. TNF-alpha is a cytokine, or a protein, that signals the body to create inflammation. In psoriasis and psoriatic arthritis, there is excess production of TNF-alpha in the skin or joints. That leads to the rapid growth of skin cells and/or damage to joint tissue. Blocking the TNF-alpha production helps stop the inflammatory cycle of psoriatic disease.
Stelara (ustekinumab) works by selectively targeting the proteins, or cytokines, interleukin-12 (IL-12) and interleukin 23 (IL-23). Interleukins-12/23 are associated with psoriasis inflammation.
How are they used?
The biologics are taken by injection or by IV infusion. Enbrel, Humira and Simponi are injected in the legs, abdomen or arms, typically by the individual with psoriasis or a family member. Stelara is administered as a subcutaneous injection by a health care provider. Remicade is given through IV infusion in a doctor’s office or infusion center. Biologics are prescribed for individuals with moderate to severe cases of plaque psoriasis and psoriatic arthritis. They are a viable option for those who have not responded to or have experienced harmful side effects from other treatments. The TNF-alpha blockers help reduce the progression of joint damage in psoriatic arthritis.
Do not take biologics if:
- Your immune system is significantly compromised;
- You have an active infection.
Screening for tuberculosis (TB) or other infectious diseases is required before starting treatment with Enbrel, Humira, Remicade, Simponi and Stelara.
What are the risks?
Anyone considering taking a biologic drug should talk with his or her doctor about the short- and long-term side effects and risks. It is important to weigh the risks against the benefits of using the drugs.
Biologics can increase the risk of infection. Individuals who develop any sign of an infection such as a fever, cough or flu-like symptoms or have any cuts or open sores should contact their doctor right away.
The impact of biologics on developing fetuses or nursing infants is not known. Biologics should only be prescribed to pregnant or nursing women if there is a clear medical need.
Common side effects for biologics include:
- Respiratory infections
- Flu-like symptoms
- Injection site reactions
These side effects are generally mild and in most cases do not cause individuals to stop taking the medication.
Rare side effects for biologics include:
- Serious nervous system disorders, such as multiple sclerosis, seizures, or inflammation of the nerves of the eyes;
- Blood disorders;
- Certain types of cancer.
Call your doctor if you are experiencing any side effects with biologic drugs. For specific side effect information, download the individual product fact sheet.
Using biologics with other psoriasis treatments
All the current biologics can be used with other treatments such as phototherapy or topicals, though using phototherapy along with Remicade may increase skin cancer risk.
Enbrel, Humira and Remicade are shown to be safe and effective when taken with methotrexate. Talk to your doctor about whether using any other treatments with a biologic is right for you.
For more information on individual biologics, download the product fact sheets »