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 much more widely available as treatments in the last decade.
Biologics are different from traditional systemic drugs that impact the entire immune system. Biologics, instead, 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 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
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. This can lead to improvement in symptoms 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
Tremfya (guselkumab) and Ilumya (tildrakizumab-asmn) work by targeting interleukin 23 (IL-23). This cytokine is linked with inflammation in psoriasis and psoriatic arthritis. Tremfya and Ilumya work to reduce psoriatic symptoms and slow disease progression.
How are they used?
The biologics are taken by injection or by IV infusion. Cimzia, Cosentyx, Enbrel, Humira, Simponi and Taltz are injected in the legs, abdomen or arms, typically by the individual with psoriatic disease 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. 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. Studies show that 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 Cosentyx, 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.
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 »
Do you have additional questions about biologics?
NPF’s Patient Navigation Center is the world's first, personalized support center for psoriatic disease. Our Patient Navigators can answer your questions about biologics, including understanding their side effects and helping assess potential risks. For free and confidential assistance, contact our Patient Navigators »