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Medications Information: Biologics

Biologic drugs, or “biologics”, are a relatively new class of treatment for psoriasis and psoriatic arthritis. They are given by injection or intravenous (IV) infusion.

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, the advent of modern day molecular biologic techniques has accelerated their use in modern day medicine tremendously in the last decade.

Different from the traditional systemic drugs that impact the entire immune system, biologics target specific parts of the immune system. The biologics used to treat psoriatic diseases act by blocking the action of a specific type of immune cell called a T-cell, or by blocking proteins in the immune system, such as tumor necrosis factor=alpha (TNF-alpha) or interleukins 12 and 23. These cells and proteins all play a major role in developing psoriasis and psoriatic arthritis.

Tumor Necrosis Factor-alpha (TNF-alpha) Blockers

Enbrel (etanercept), Humira (adalimumab), Remicade (infliximab) and Simponi (golimumab) are drugs that block TNF-alpha. TNF-alpha is an immune system mediator called a cytokine that is a key mediator of 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 the TNF-alpha helps to stop the inflammatory cycle of psoriatic diseases.

Interleukin 12/23

Stelara (ustekinumab) works by selectively targeting inflammatory chemicals in the body called IL12 and IL23.  Interleukins-12/23 are also chemicals that mediate inflammation.  These chemicals are abundant in psoriasis skin and are thought to promote the accumulation of the psoriasis causing T cells.

How are they used?

The biologics are taken by injection or by IV infusion.  Enbrel, Humira and Simponi are injected in the legs, abdomen or arms, typically by the individual with psoriasis 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.

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.  The TNF blockers have been shown to 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 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 a 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 from the National Psoriasis Foundation website: www.psoriasis.org.

Using biologics with other psoriasis treatments:

All of the biologics currently on the market can be used with other treatments such as phototherapy or topical. There is data that suggests that phototherapy in combination with Amevive may improve the outcome.  Using phototherapy along with Remicade may increase your risk of skin cancer.

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.