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.
Unlike systemic drugs, which target 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 block protein, 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
The National Psoriasis Foundation Medical Board has issued a statement on biosimilar substitution. Read the statement »
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 a 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 some.
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.
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?
You should talk to your doctor about all risks associated with biologic drugs before beginning treatment. It is always 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, or if you start to experience specific side effects, 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 the risk of skin cancer.
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.
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Last updated by the National Psoriasis Foundation.