Biologics: A New Frontier in Psoriasis Treatment
Biologics, or biologic drugs, are medications derived from living organisms, which is why they are referred to as biologics — “bio” meaning “life.” They can be produced from human or animal cells, bacteria, and other microorganisms. A common example of a biologic is a vaccine.
These drugs contain proteins that target specific cells within your body, impacting the immune system by interfering with the inflammatory process. Due to this mechanism, biologics are employed to treat autoimmune skin conditions like psoriasis.
In 2013, it was estimated that around 7.4 million people in the United States were affected by psoriasis.
Treatment options for psoriasis include topical treatments, prescription medications, and phototherapy. If you have moderate to severe psoriasis and your current treatment isn’t effective, it may be time to consider biologic drugs.
So, what are biologics exactly? Biologics are targeted therapies that block certain proteins (cytokines) responsible for inflammation. They specifically target the components of the immune system that trigger the inflammation seen in psoriasis-affected skin.
While biologics can be highly effective for psoriasis treatment, they may alter your immune response, potentially increasing your susceptibility to infections and malignancies.
How Do Biologics Work?
Biologics, also known as biologic response modifiers, alter the way certain systems in the body function or respond. These medications are administered through injection (similar to a vaccine shot) or an intravenous (IV) infusion into your bloodstream. They cannot be taken orally because they are not stable enough to withstand stomach acid and face absorption barriers in the gastrointestinal tract.
Biologics for psoriasis operate by blocking the immune system from producing specific cytokines—these are inflammatory proteins that trigger the skin condition. These biologics primarily target cytokines produced via two main immune system pathways: Th1 and Th17.
Th1 Pathway
Some biologics target cytokines produced by T cells within the Th1 pathway, which are implicated in psoriasis. Th1 cells elevate levels of inflammatory cytokines that contribute to psoriasis, including:
- Interferon-gamma (IFN-γ)
- Tumor necrosis factor-alpha (TNF-α)
- Interleukin-12 (IL-12)
Th17 Pathway
Other biologics target cytokines produced by Th17 cells, which also play a role in psoriasis. Th17 cells promote the secretion of IL-17 cytokines. Biologics targeting this pathway can inhibit these inflammatory cells and reduce the onset of psoriatic arthritis, a type of arthritis that can develop in individuals with psoriasis.
What Biologics Are Currently Available?
There are currently 11 biologics approved for the treatment of 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 detailed information and updates on these biologics.
These biologics target different cytokines and inflammatory mediators, so discussing with your doctor which biologic is right for you is essential. Research on developing new biologics for psoriasis is ongoing.
Can Biologics Be Combined with Other Treatments?
A single drug or therapy regimen may not be effective for everyone with psoriasis. If single drugs aren’t working for you or have lost their effectiveness over time, it might be time to consider combining biologics with other treatments.
There are three main benefits to using a combination approach:
- It can decrease the risk of reaching toxic levels with a single drug.
- Individual drugs can be prescribed at lower doses.
- A combination approach can be more successful than a single treatment option.
Research from 2014 indicated that patients taking a biologic alone or in combination with another treatment generally reported higher satisfaction compared to those relying solely on topical therapies or acitretin (Soriatane).
Methotrexate vs. Biologics
Methotrexate is a type of medication known as an antimetabolite or a disease-modifying antirheumatic drug (DMARD). It’s commonly used to treat cancer by inhibiting the growth of cancer cells. Additionally, methotrexate is used to treat psoriasis and other autoimmune conditions, such as rheumatoid arthritis, because it suppresses the immune system as a whole.
In comparison, biologics treat psoriasis and other autoimmune conditions by specifically targeting components of the inflammatory process. Instead of slowing down the entire immune system, biologics work by blocking or modulating specific parts of it.
A study compared the effectiveness of methotrexate versus a biologic drug for rheumatoid arthritis. Researchers found that individuals treated with biologics experienced fewer disease symptoms compared to those treated with methotrexate.
More research is needed to determine if biologics have the same effectiveness for psoriasis.
Treatment for Different Types of Psoriasis
There are various types of psoriasis, and you may have one or more types simultaneously. Different biologics may be used to treat different forms of the disease.
For instance, scalp psoriasis may be best treated with the following biologics:
- Ustekinumab (Stelara)
- Infliximab (Remicade)
- Adalimumab (Humira)
- Etanercept (Enbrel)
Guttate psoriasis, which is characterized by small, red spots on the skin and can begin in childhood, has been shown to respond well to treatment with the biologic ustekinumab (Stelara).
Cost of Biologics
Treatment with biologics can be more expensive than other types of psoriasis treatments. The primary reason for the higher cost is the significant investment required for research and development.
Another factor contributing to the higher cost is that biologics are typically administered via injection. While some biologics can be self-administered, others necessitate visits to a doctor’s office or hospital, adding to the overall expense.
Additionally, biologics are relatively new drugs and often lack competing brands in the market to drive down prices.
Without health insurance, most biologic treatments typically range from $10,000 to $25,000 annually. Secukinumab (Cosentyx) is the most expensive biologic, with a yearly cost of $60,906 in 2018. In contrast, phototherapy treatment for psoriasis had an out-of-pocket cost of approximately $1,600 per year in 2018.
If your health insurance covers biologic treatments, you may only need to pay your deductible or a percentage of the medication’s cost. Contact your insurance provider to determine your coverage.