Biologics for Psoriasis: Dermatologists’ choices in injections treatment
Dr. Eric Howell, board-certified dermatologist, talks about the most widely prescribed biologics for psoriasis, how they work, their advantages, symptoms, and answers to patients’ frequently asked questions.
Table of Content:
What are biologics? | How do they work? | How can I get them? | How are biologics administered? | Best biologics for psoriasis | How to decide if they are right for you? | FAQ
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What are biologics (psoriasis injections)?
Biologics (also referred to as injections for psoriasis) are a type of treatment containing components of living organisms. Biologics are produced using biotechnology, where scientists engineer therapies from living cells to precisely target immune system components or disease pathways1.
Unlike traditional drugs, which are chemically synthesized and can have a broad effect on the body, biologics are designed to target specific parts of the immune system to reduce inflammation or block certain cellular processes involved in disease progression.
Dr. Eric Howell, board-certified dermatologist, says that because biologics are more targeted in their action and are derived from living cells, they usually offer additional benefits over traditional therapies, such as fewer side effects and improved disease management2.
What are biologic medications used for?
Biologic medications primarily focus on treating conditions that involve chronic inflammations and the immune system, such as:
- Autoimmune diseases
- Rheumatoid arthritis
- Psoriasis and psoriatic arthritis
- Inflammatory bowel disease
- Multiple sclerosis
- Chronic inflammatory conditions
- Osteoporosis3 4
How do biologics work for psoriasis?
Biologics treat psoriasis by targeting specific parts of the immune system involved in the disease’s development, leading to a reduction in inflammation and a decrease in the rapid production of skin cells:
- Target key immune system components: Biologics focus on specific proteins or cells in the immune system, such as tumor necrosis factor (TNF), interleukin-17 (IL-17), and interleukin-23 (IL-23), which are overactive in psoriasis5.
- Reduce inflammation: By inhibiting these targets, biologics reduce the underlying inflammation that contributes to psoriasis symptoms6.
- Slow down skin cell turnover: This decrease in inflammation helps normalize the skin cell production process, reducing the formation of psoriasis plaques7.
- Improve skin appearance: Patients often see significant improvements in skin clarity and a reduction in the coverage of psoriatic plaques8.
How are biologic medications administered?
According to Dr. Howell, biologics are administered through injection or infusion due to their large size and complexity, which prevent absorption through the digestive system. Oral administration would break down these protein-based medications, making them ineffective. Injecting or infusing biologics directly into the bloodstream or tissues ensures that the medication maintains its integrity, reaches its target effectively, and has the intended therapeutic effect. This method also allows for more precise delivery to specific sites in the body, enhancing the drug’s efficacy and reducing side effects.
List of biologics for psoriasis treatment
These are all the biologic drugs (psoriasis injections) approved by the FDA for the treatment of moderate to severe psoriasis are the following.
What are the best biologics for psoriasis?
According to Dr. Howell, the best psoriasis treatment injections (biologics) are Tremfya (Guselkumab), Skyrizi (Risankizumab), and Taltz (Ixekizumab) due to their targeted mechanisms of action and proven efficacy in clinical trials.
Tremfya (Guselkumab)
What is it used for? | Plaque psoriasis |
How is it administered? | Prefilled syringe. Should administer first two shots 4 weeks apart and then once every 8 weeks. |
Common side effects | Headaches, diarrhea or other stomach issues, pain or swelling in your joints, upper respiratory infections9 |
Manufacturer | Janssen |
Patient savings program | Janssen CarePath Tremfya savings program |
Biosimilar available | No |
Skyrizi (Risankizumab)
What is it used for? | Plaque psoriasis |
How is it administered? | Prefilled syringe or pen. Should administer first two shots 4 weeks apart and then once every 12 weeks. |
Common side effects | Upper respiratory infection, headache, fatigue, reaction at the injection site10 |
Manufacturer | Abbvie |
Patient savings program | Skyrizi patient support |
Biosimilar available | No |
Taltz (Ixekizumab)
What is it used for? | Plaque psoriasis and psoriatic arthritis |
How is it administered? | This is a shot you give yourself every 2 weeks for 12 weeks, then once every 4 weeks after that. |
Common side effects | Upper respiratory infections, nausea, fungal infections. Your doctor will check you for TB before prescribing this medication and watch you for signs of the disease while you use it11 |
Manufacturer | Eli Lilly |
Patient savings program | Taltz savings support |
Biosimilar available | No |
Why are these the most prescribed biologics for psoriasis?
According to Dr. Howell, these three biologic medications have proofed to be the most effective at clearing the skin in numerous studies when compared to other biologic therapies available. That is why they have become the most commonly used biologic therapies for plaque psoriasis due to their superior effectiveness and relative safety compared to others.
How can I get a biologics prescription for my psoriasis?
You can get prescription treatment for psoriasis by having a photo-consultation with an online dermatologist. All you need to do is take some photos, answer a clinical questionnaire, pay the $59 fee with your credit card or Apple pay and wait less than 48 hours to get your prescription.
Request a prescription
How to decide if biologics are right for you?
The decision to use psoriasis injection treatments (biologics) mainly relies on five important factors.
- Quantifying the extent of psoriasis on your skin
- Impact that psoriasis has on your life
- Insurance coverage
- Health and medical history
- Considering your personal comfort with the treatment methods
Quantifying the extent of psoriasis on your skin
Dr. Howell says that the decision to start biologic treatment often starts by assessing the severity of your psoriasis, which is typically measured by the percentage of body surface area (BSA) affected. Moderate psoriasis generally covers 3% to 10% of the BSA, while severe psoriasis affects more than 10%. Biologics are particularly recommended for those with moderate to severe conditions.
Impact that psoriasis has on your life
Psoriasis can profoundly affect quality of life, influencing physical comfort, emotional well-being, and social interactions. Consider if your symptoms restrict your daily activities, work, or personal relationships. If psoriasis causes significant distress or impedes your lifestyle, biologic therapies might be a beneficial option to explore.
Insurance coverage
The cost of biologic treatments can be substantial, ranging between between $10,000 to $30,0000 per year. These elevated costs make insurance coverage a crucial factor in your decision-making process. Prior authorization is often required, and insurers may have specific criteria for coverage, such as trying more cost-effective treatments before approving the coverage of biologics. Understanding your insurance plan’s stipulations for biologic medications is essential to access and afford these therapies.
Reviewing your health profile
Biologics work by targeting specific parts of the immune system, which can increase susceptibility to infections among other potential side effects. Your overall health, including any existing conditions (e.g., history of infections, liver or kidney issues), should be thoroughly evaluated. Discuss with your healthcare provider whether biologics are a safe and suitable option based on your medical history and current health status.
Considering your personal comfort with the treatment method
Biologic medications are typically administered via injection and may cause some serious side effects, therefore, even if your doctor has recommended biologic medications and they are covered by your health insurance you may want to choose alternative treatment such as a combination of stress management techniques, topical prescription medications for psoriasis and over-the-counter creams and supplements for psoriasis.
Frequently asked questions about biologics
What is the price of biologic medications for psoriasis?
The cost of biologic medications for psoriasis in the United States can range between between $10,000 to $30,0000 per year.
Are biologics covered by insurance?
Biologic medications are covered by insurance in some cases, but the extent of coverage and out-of-pocket costs can vary widely based on the insurance plan, and the specific biologic prescribed. Insurance plans often require prior authorization and may require patients to try less expensive treatments before approving these costly treatments.
Are psoriasis injections the most effective treatment?
Psoriasis injections, which typically include biologic medications, are among the most effective treatments for severe psoriasis, particularly when topical treatments and phototherapy have not delivered significant improvement. The effectiveness of these injectables for psoriasis is due to their targeted approach; they specifically aim at parts of the immune system involved in the inflammation and overproduction of skin cells characteristic of psoriasis. This targeted action can lead to significant improvements in skin symptoms and a higher rate of skin clearance compared to conventional systemic therapies.
Can biologics be used with other psoriasis treatments?
Yes, biologics can be used in combination with other psoriasis treatments. Combining biologics with topical treatments or phototherapy to enhance efficacy and manage symptoms more comprehensively and sometimes reduce the required dose of each medication, minimizing potential side effects.
Are biologics for psoriasis worth it?
Dr. Howell says that deciding whether biologics for psoriasis are “worth it” is a very individual choice that depends on various factors, including the severity of your condition, to what extent the condition affects your life, whether other treatments have worked for you in the past or not, and your insurance coverage.
How long do you need to take biologics for psoriasis?
Dr. Howell says that the duration for which a person can stay on biologic therapy for conditions like psoriasis varies widely among individuals and depends on several factors, including the effectiveness of the treatment, the patient’s tolerance to the medication, the management of any side effects, and other individual circumstances.
When to stop biologics for psoriasis?
Dr. Eric Howell says that deciding when to stop biologics for psoriasis involves careful consideration, as there are currently no clear guidelines on the optimal duration of biologic therapy for this condition. A significant moment to contemplate discontinuing or taking a break from biologics is when psoriasis lesions have fully resolved, leading to substantial lesion clearance or even complete disease resolution.
In such cases, patients are encouraged to discuss the potential of stopping or pausing their biologic treatment with their dermatologist. He also mentioned that it is extremely important that patients never attempt to stop their treatment without medical guidance.
On the other hand, there are several reasons why taking a break from biologics may be advisable, including experiencing an illness, getting a vaccination, an upcoming surgery, or during pregnancy. Each of these scenarios presents unique considerations that should be consulted with a healthcare provider to ensure the well-being of the patient.
Can you switch from biologics to topical treatments when most psoriasis symptoms disappear?
Yes, switching from biologics to topical psoriasis treatments when most symptoms have disappeared is a strategy Dr. Howell often discusses with his patients. This approach is often part of a treatment plan called “step-down” therapy, where the goal is to maintain disease control with less intensive treatments after achieving significant improvement or remission.
What biologics can be used by children?
In some cases, biologic medications are recommended for treating psoriasis in children, especially those with a severe form of the condition. These treatments can be highly effective for young patients. The U.S. Food and Drug Administration (FDA) has authorized the use of specific biologics for children with moderate or severe psoriasis, including:
- Enbrel (Etanercept) can be used by children as young as 4 years of age12
- Cosentyx (Secukinumab) can be used by children 6 years of age and above13
- Stelara (Ustekinumab) can be used by children aged 6 and above14
- Taltz (Ixekizumab) can be used for children as young as age 615
Do biologics cause weight gain?
Biologics, as a class of medication used to treat psoriasis and other inflammatory conditions, and weight gain is not typically associated as a common side effect.
Article References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2887522/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820177/
https://www.ncbi.nlm.nih.gov/books/NBK542200/
https://pubmed.ncbi.nlm.nih.gov/26463248/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8962336/
https://www.janssenlabels.com/package-insert/product-monograph/prescribing-information/TREMFYA-pi.pdf
https://www.enbrel.com/patient-resources/start-enbrel
https://www.cosentyx.com/kids-and-teens/pediatric-psoriasis
https://www.stelarainfo.com/plaque-psoriasis/treatment-information/adolescent-psoriasis
https://www.taltz.com/hcp/dermatology/pediatric-efficacy-safety