An Overview of Biologics for Treating Psoriatic Disease

Psoriatic disease is an autoimmune condition that includes psoriasis and psoriatic arthritis (PsA). Both conditions are the result of an overactive immune system and primarily affect the joints and skin throughout the body. Biologic drugs, or simply “biologics,” for psoriatic disease are prescribed in cases when the disease has not responded to other treatments. These medications are designed to slow or stop joint damage, inflammation, and progression of psoriatic disease.

What Are Biologics?

Biologics work by mimicking substances naturally made by your immune system. These drugs are manufactured using genetic engineering, which means that certain genes—those that would normally guide the production of human immune system proteins—are produced artificially in large amounts.

Because these drugs are active antibodies, they must be injected in the skin or given intravenously (through a vein). Most biologics for psoriatic disease are given by self-injection.

Some biologics work quickly, within the first two weeks, but you may not see their full effects until two to three months later. If you don’t respond to one biologic, your healthcare provider will likely try a different one.

Many people take a biologic with a disease-modifying antirheumatic drug (DMARD), usually methotrexate, one of the most effective and widely used medications for psoriatic disease and other types of inflammatory arthritis. It is also one of the safest arthritis drugs, although there are misconceptions that it is highly toxic.

Biologic Treatment of Psoriatic Disease

Many different biologic drugs have been approved by the U.S. Food and Drug Administration (FDA) for treating moderate to severe psoriatic disease. They are not considered a first-line treatment because of their cost and side effects. 

While biologics are usually prescribed with a DMARD, they can also be prescribed alone. When a person with disease starts taking a biologic drug, they will also remain on their current treatment plan, which may include non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and/or DMARDs.

How Biologics Work

When certain proteins such as cytokines (molecules that over-excite immune system cells, causing them to attack healthy parts of the body) and tumor necrosis factor (TNF) proteins appear in excess amounts, they may be responsible for inflammation and eventual joint damage. Biologic drugs can counter the effects of these substances by inhibiting or inactivating them.

Biologics can also treat psoriasis symptoms and work well to treat the condition. They block TNF proteins and interleukins and bind to proteins that cause inflammation. They also curb T-cells—a form of white blood cells—which facilitate the production of psoriasis plaques.

When these processes are short-circuited, inflammation is eased and there is less growth of thick, scaly skin. Research has shown biologics are good at treating psoriasis, especially those that target IL-17- and IL-23 proteins.

Commonly Prescribed Biologics

The current types of biologics available for treating psoriatic disease include those that inhibit cytokine and tumor necrosis factor (TNF) proteins, as well as interleukin-17 (IL-17) inhibition, IL-12/23, T cell co-stimulation, CTLA4-Ig, and Janus-kinase (JAK) inhibition.

The most commonly prescribed biologics for psoriatic disease include:

• Remicade (infliximab)
• Enbrel (etanercept)
• Humira (adalimumab)
• Simponi (golimumab) 
• Cimzia (certolizumab)
• Stelara (ustekinumab)
• Cosentyx (secukinumab)
• Taltz (ixekizumab)
• Tremfya (guselkumab)
• Orencia (abatacept)
• Skyrizi (risankizumab-rzaa)

Humira, Enbrel, Remicade, Cimzia, and Simponi target TNF proteins while Cosentyx, Skyrizi, Stelara, Taltz, and Tremfya target specific interleukin proteins. Orencia targets T-cells. Cosentyx and Stelara are prescribed after TNF-inhibitors haven’t helped, or if a person is unable to take TNF-inhibitors due to side effects or other risks.

Use and Side Effects

Biologics are typically given by injection and tend to work quickly to relieve inflammation and other psoriatic disease symptoms. Biologics are typically given by injection and tend to work quickly to relieve inflammation and other psoriatic disease symptoms.

Most studies show that relief can be seen within four to six weeks. However, some people may notice an improvement after the first or second injection.

A common side effect of injectable medications is skin reactions at the injection site. The most significant and concerning side effect is the increased risk for all types of infections including tuberculosis (TB), a bacterial infection that mainly affects the lungs.

Your healthcare provider will recommend that you stop the biologic if you develop an active infection and need treatment with an antibiotic.

Additionally, patients with HIV can develop severe psoriasis. Therefore, it is important to screen for HIV before starting biologic therapy in patients with psoriasis.

If you take a biologic through an IV, you may experience infusion reactions, including flu-like symptoms, fever, chills, nausea, or headache.

Additional side effects of biologics include:

• Allergic reaction hypersensitivity
• Chills and/or fever
• Weakness and/or fatigue
• Gastrointestinal troubles, including diarrhea, constipation, nausea, and vomiting
• Rash and/or itching
• High glucose levels
• Cough
• Dizziness

Rare, but possible side effects, include:

• Shortness of breath
• Peripheral edema (accumulation of swelling in the lower extremities)
• Muscle aches and pain
• Decreased appetite
• Insomnia
• Abdominal pain
• Increased triglyceride (fat storage in the body) levels

Call your healthcare provider right away if you experience signs of an infection, including fever, extreme fatigue, swollen lymph nodes in the neck, armpits, or groin, headache, and nausea.

Biologic drugs are not generally recommended for pregnant and breastfeeding women, as these drugs have not been studied adequately in these groups. If you are pregnant or breastfeeding, talk to your healthcare provider about whether you need to stop taking your biologic therapy.

Usage With Psoriasis Treatments

In addition to DMARDs like methotrexate, current biologics can be used in conjunction with these psoriasis therapies:

Topical treatments, which are applied directly to the skin and are a first-line treatment for psoriasis. They slow down or normalize excessive skin cell growth and reduce skin inflammation.

Phototherapy, also called light therapy, which exposes skin to ultraviolent light under medical supervision. Exposure needs to be consistent to penetrate skin and slow skin cell growth. Phototherapy may, however, increased the risk of skin cancer if a person is taking TNF-inhibitors or vice versa. This is because photosensitivity is a side of effect of these medications.

A Word From Verywell

Biologics are recommended for people living with moderate-to-severe psoriatic disease. Some individuals, however, are not ideal candidates for these treatments.

For example, people who have compromised immune systems may not be able to take biologics or will need to be very closely monitored. This is because biologics suppress the immune system and having a compromised immune system and taking these medications can increase the risk of potentially fatal infections.

The costs of these drugs may also be a barrier for some people. Your healthcare provider’s office should have information about patient assistance programs if the cost is a problem.

Remember to follow your treatment plan as your healthcare provider prescribes and call your healthcare provider if you are experiencing any serious side effects of your biologic treatment. It is also important to be aware of side effects that require immediate medical attention.