Moderate to Severe Psoriasis and Psoriatic Arthritis: Biologic Drugs

Biologic drugs, or "biologics," are given by injection (shot) or intravenous (IV) infusion (a slow drip of medicine into your vein). 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, modern-day techniques have made biologics a viable treatment option in the last decade.

Biologics are different from traditional systemic drugs that impace the entire immune system. Biologics only target specific parts of the immune system. The biologics used to treat psoriatic disease block the action of a specific type of immune cell called a T-cell. Or they block proteins in the immune system, such as tumor necrosis factor-alpha (TNF-alpha), interleukin 17-A or interleukins 12 and  23. These cells and proteins all play a major role in developing psoriasis and psoriatic arthritis.

The following are biologics approved for psoriatic disease. Some are approved for psoriasis, psoriatic arthritis or both. 

Treatment Comparison Chart

Biosimilar substitution

The National Psoriasis Foundation Medical Board has issued a statement on biosimilar substitution. Read the statement »

Download the Systemic Treatments: Biologics and Oral Treatments booklet »

Tumor necrosis factor-alpha (TNF-alpha) inhibitors

Cimzia (certolizumab pegol)Enbrel (etanercept)Humira (adalimumab)Remicade (infliximab)Simponi (golimumab) and Simponi Aria (golimumab) are drugs that block TNF-alpha. TNF-alpha is a cytokine, or protein, that prompts 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 TNF-alpha production helps stop the inflammatory cycle of psoriatic disease.

Interleukin 12 and  23 (IL-12/23) inhibitors

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 psoriatic inflammation.

Interleukin 17 (IL-17) inhibitors

Cosentyx (secukinumab) and Taltz (ixekizumab) block a cytokine, or protein, called interleukin 17 (IL-17), which is involved in inflammatory and immune responses. Siliq (brodalumab) blocks the receptor of this cytokine, IL-17 receptor A (IL-17 RA) through which IL-17 mediates the inflammatory and immune responses. There are elevated levels of IL-17 in psoriatic plaques. By interfering with IL-17 signaling, Cosentyx, Siliq and Taltz interrupt the inflammatory cycle of psoriasis, which can lead to symptom improvement for many people who take it.

T-cell inhibitors

Orencia (abatacept) targets T-cells in the immune system. T-cells are a type of white blood cell that is involved in the inflammation in psoriasis and psoriatic disease. Orencia inhibits T-cells from becoming activated to reduce inflammation. 

Interleukin 23 (IL-23) inhibitors

Ilumya (tildrakizumab-asmn)Skyrizi (risankizumab-rzaa) and Tremfya (guselkumab) work by targeting interleukin 23 (IL-23). This cytokine is linked with inflammation in psoriasis and psoriatic arthritis. Ilumya, Skyrizi and Tremfya work to reduce psoriatic symptoms and slow disease progression. 

How are they used?

Biologics are taken by injection or by IV infusion. Cimzia, Cosentyx, Enbrel, Humira, Ilumya, Simponi, Skyrizi, Stelara, Taltz and Tremfya are injected in the legs, abdomen or arms by the patient, a health care provider or a family member. Remicade and Simponi Aria are given through IV infusion in a doctor’s office or infusion center. Orencia can be taken as an injection or by IV infusion.

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.

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 often required before starting treatment with biologics. 

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. If you develop any sign of an infection, such as a fever, cough or flu-like symptoms, you should contact your doctor right away.

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 your skin cancer risk.

Cimzia, 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 »

Learn the latest in biologics

Anthony Fernandez, M.D., Ph.D., will walk you through the latest news and what’s coming soon in the world of biologics in this informative webinar.

 

Test your treatment IQ

How much do you know about your psoriatic disease treatment options? Put your knowledge to the test with our treatment quiz and let NPF help you fill in some of the gaps.

 

Last updated  by the National Psoriasis Foundation.