From healthcentral.com
Learn about potential benefits, drawbacks, and which treatments delivered via a shot may be right for managing severe symptoms
Psoriasis is a full-body, autoimmune condition that often appears on the skin as dry, flaky patches, referred to as plaques. It can sometimes be managed with topical treatments, but more severe cases often required advanced therapies such as biologic medications. Biologics used to treat psoriasis are often given by injections, either at home or in a clinical setting. Depending on your insurance, biologics can be an expensive choice of treatment but may also be well worth the cost.
Most experts agree: Biologics have been a game changer for psoriasis treatment, says Kurt Ashack, M.D., a dermatologist at Dermatology Associates of West Michigan in Grand Rapids, MI. “Biologics last in the body for longer, and that keeps the psoriasis at bay for much longer,” he says. Wondering exactly what biologics are and how injections for psoriasis work? Our experts break it all down here, including how injections have become a new standard level of care for those with moderate to severe psoriasis.
What Are Biologics?
Not long ago, traditional medications used to treat psoriasis impacted the entire immune system. Biologic medications are different from those older medications, quieting only a portion of the immune system that is overactive because of psoriasis. The Food and Drug Administration has approved at least 11 different biologics to treat psoriasis. At least one of the medications, infliximab, requires an infusion (through an IV) but the others can be received by an injection. “The injections aren’t very painful, and they range from one shot a month to 4 shots a year,” says Dr. Ashack.
According to the National Psoriasis Foundation, the biologics that are used to treat psoriatic disease block proteins in the immune system including tumour necrosis factor-alpha (TNF-alpha), interleukins 12 and 23, and interleukin 17. Let’s take a closer look at each.
TNF-Alpha Inhibitors
According to the journal Clinical Immunology, more than a million people worldwide have been treated with tumour necrosis factor-alpha (TNFα) inhibitors for a variety of conditions including rheumatoid arthritis, inflammatory bowel disease, and psoriatic disease. TNF-alpha inhibitors help reduce pro-inflammatory cytokines that increase inflammation through several pathways. Blocking the TNF-alpha production helps stop the inflammation related to psoriatic disease. Some of the TNF-alpha inhibitors approved for psoriasis include:
Cimzia (certolizumab pegol)
Enbrel (etanercept)
Humira (adalimumab)
Remicade (infliximab)
Simponi (golimumab)
Simponi Aria (golimumab)
IL-12/23 Inhibitors
“This injectable biologic works by selectively targeting the proteins, or cytokines, interleukin 12 (IL-12) and interleukin 23 (IL-23),” says Adam Kaye, Pharm.D., a clinical professor of pharmacy at the University of the Pacific in Stockton, CA. Stelara (ustekinumab) is the biologic that is approved for psoriasis and targets both the IL-12 and IL-23 pathways, he says. “When patients take this biologic, they will take an initial dose subcutaneously (under the skin), followed by a second dose at week four, then every 12 weeks after the initial dosing,” he explains. Interleukins 12/23 are associated with psoriasis inflammation.
IL-17 Inhibitors
Interleukin 17 is also associated with psoriatic disease. According to Kaye, there are several approved IL-17 inhibitors used to treat psoriasis including:
Cosentyx (secukinumab)
Taltz (ixekizumab)
Siliq (brodalumab)
The latest in this class to be approved is Bimzelx (bimekizumab-bkzx). Kaye says the most common adverse effects of this class of medication is infection risk. Each of the IL-medications for psoriasis are taken subcutaneously by injection, explains Kaye.
IL-23 Inhibitors
Kaye says there are three main interleukin 23 inhibitors used for psoriasis: Tremfya (guselkumab), Ilumya (tildrakizumab), and Skyrizi (risankizumab). These biologics are used for both psoriasis and psoriatic arthritis. According to the National Psoriasis Foundation, IL-23 inhibitor medications can treat psoriatic disease and also help slow psoriatic disease progression. According to Kaye, a common adverse effect of IL-23 inhibitors is an increased risk of infection.
Does Methotrexate Treat Psoriasis?
Methotrexate, approved in 1972 for psoriasis treatment, is still prescribed in some circumstances, especially if cost is an issue. Methotrexate is usually taken as a pill and works more broadly compared to the biologic medications to dampen an overactive immune system. According to the American Academy of Dermatology Association, most patients who are prescribed methotrexate, see less symptoms from psoriasis in four to six weeks. However, according to Kaye, methotrexate isn’t for everyone, because it comes with potentially serious side effects. “Methotrexate is a medication with well-known pulmonary and liver risks that clinicians are well aware of and know they need to monitor for,” he explains.
Possible Medication Side Effects
Dr. Ashack says that while all immunosuppressant medications can make you an easier target for infections, your immune system takes less of a hit on a biologic as compared to methotrexate. “The targeted therapies for psoriasis like Skyrizi and Tremfya are so specific to psoriasis that the body does not utilize this pathway for a lot of other things like fighting off infections,” he says. Still, “biologics do cause an increased risk in infection, but they are much safer than older therapies like methotrexate.”
Kaye agrees and says that the newer targeted medication side effects can be subtle, but something to still be aware of. The need to avoid infections due to immunosuppressive therapies is a basic philosophy that should be shared with patients by the prescriber when biologic therapy begins, he adds.
Other Treatment Options
Especially for mild psoriasis, there are other treatment options to try before biologics. Topical therapies such as moisturizing lotion, steroid cream, medicated shampoo, vitamin D ointment, and retinoid cream are all effective options for some people with milder forms of the disease, per the Cleveland Clinic.
But if you have more severe psoriasis, or your psoriasis isn’t improving with your existing treatment, it may be time to talk to your dermatologist about a new approach. “Injectable biologics often make the psoriasis melt away so that you don’t have to use your topical therapy anymore, or if so, very little,” Dr. Ashack reports.
Bottom Line on Psoriasis Injections
In recent years, new medications called biologics have been approved to treat moderate to severe psoriasis. These medications target different specific parts of the immune system. Because they are so targeted, they are often very effective and avoid suppressing your entire immune system.
These medications are usually taken several times a year by injection. While effective, biologic medications can be unaffordable for some. While biologics are more targeted, they still have potential side effects, and you will need to maintain close communication with your provider when taking a biologic medication. According to the American Academy of Dermatology Association, if you are prescribed a biologic, you should contact your doctor if you have any side effects, stop taking the medication, have difficulty with the injection, or plan to become pregnant.
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