Biologics, or biologic drugs, are types of medications that are made from living organisms. This is why they are called biologics — “bio” means “life.”
They can be made from human or animal cells and bacteria and other microorganisms. For example, vaccines are a type of biologic.
Biologics have proteins that target specific cells inside your body and affect the immune system by interfering with the inflammatory process. For this reason, biologics are used to treat autoimmune skin conditions like psoriasis.
In 2013, it was estimated that around 7.4 million people in the United States have psoriasis.
There are several treatment options for psoriasis, including topical (skin) treatments, prescription drugs, and phototherapy. If you have moderate to severe psoriasis and your current treatment isn’t working, it may be time to think about trying biologic drugs.
Biologics are target-specific drugs that act by blocking certain proteins (cytokines) that cause inflammation. This means that they home in on the parts of the immune system that trigger the inflammation seen in skin affected by psoriasis.
While biologics for psoriasis can be effective, untoward reactions can result in altering your response to infection and your susceptibility to malignancies.
Biologics are sometimes called biologic response modifiers because they change how certain systems in the body act or respond.
Biologics are given by an injection (like a vaccine shot) or through an intravenous (IV) infusion into your blood vessels.
They can’t be taken by mouth (swallowed) because they’re not strong enough to survive stomach acid. There are also barriers to absorption of the biologic in the gastrointestinal tract.
Biologics for psoriasis work by blocking the immune system from making specific cytokines — inflammatory proteins — that trigger this skin condition. Psoriasis biologics target cytokines produced by two main immune system pathways: Th1 and Th17.
Th1 pathway
Some biologics target cytokines produced by immune cells called T cells, which are involved in psoriasis. Th1 cells raise levels of inflammatory cytokines that cause psoriasis, such as:
- interferon-gamma (IFN-γ)
- tumor necrosis factor-alpha (TNF-α)
- interleukin-12 (IL-12).
Th17 pathway
Some biologics target cytokines produced by Th17 cells, which can also cause psoriasis. These cells stimulate secretion of IL-17 cytokines. Biologics can stop these inflammatory cells and reduce the onset of psoriatic arthritis. (This type of arthritis can develop in people with psoriasis.)
There are currently 11 biologics for psoriasis:
- secukinumab (Cosentyx)
- etanercept (Enbrel)
- adalimumab (Humira)
- infliximab (Remicade)
- brodalumab (Siliq)
- ustekinumab (Stelara)
- ixekizumab (Taltz)
- guselkumab (Tremfya)
- certolizumab (Cimzia)
- tildrakizumab (Ilumya)
- risankizumab (Skyrizi)
The National Psoriasis Foundation provides more details and updates on these biologics.
These biologics target different cytokines and inflammatory mediators, so talk to your doctor about which biologic is right for you. Research on developing other biologics for psoriasis is ongoing.
The use of a single drug or a single therapy method may not work for everyone with psoriasis. If single drugs aren’t working for you, or aren’t working as well as they once did, it may be time to consider combining biologics with other treatments for psoriasis.
There are three main benefits of using a combination approach:
- It can decrease the possibility of reaching toxic levels with a single drug.
- The individual drugs can be prescribed at a lower dose.
- A combination approach can be more successful than a single treatment option.
Research from 2014 showed that those taking a biologic, or a biologic along with another form of treatment, are generally more satisfied than those taking topical therapies or acitrecin (Soriatane) alone.
Methotrexate is a kind of medication called an antimetabolite or disease modifying drug (DMARD). It’s typically used to treat cancer by slowing down cancer cell growth.
Methotrexate is also used to treat psoriasis and other autoimmune conditions like rheumatoid arthritis because it slows down the immune system as a whole.
In comparison, biologics treat psoriasis and other autoimmune conditions by slowing down or blocking parts of the immune system. They do this by targeting the components of the inflammatory process.
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More research is needed to find out if biologics for psoriasis have the same effects.
There are different kinds of psoriasis. You may have one type or more than one type of psoriasis. Different biologics may be used to treat the different types.
For example, scalp psoriasis may be best treated with the following biologics:
- ustekinumab (Stelara)
- infliximab (Remicade)
- adalimumab (Humira)
- etanercept (Enbrel)
Guttate psoriasis causes small red spots on the skin. It can begin in childhood. Medical
Treatment with biologics might be more expensive than other kinds of psoriasis treatments. The biggest reason biologics are more expensive is because of the cost associated with research and development of these drugs.
Another reason for the higher cost of treating psoriasis with biologics is because they are injected drugs. While you can self-administer several drugs in this category, others may require a visit to the doctor’s office or a hospital.
Another reason is that biologics are newer drugs, and they don’t yet have competing brands in the market to lower the price.
Without health insurance, treatment with most biologics typically costs from $10,000 to $25,000. Secukinumab (Cosentyx) is the most expensive biologic, which in 2018 had a yearly cost of $60,906. In comparison, phototherapy treatment for psoriasis had an out-of-pocket cost of about $1,600 per year in 2018.
If your health insurance covers biologics treatment, you may have to only pay your deductible or a percentage of the cost of the medication. Contact your insurance provider to find out what your coverage is.
If you feel like your current psoriasis treatment isn’t working, talk to your doctor about biologics. Using biologics, or a combination of biologics with traditional drugs, may be the answer for you.