Biologics

Biologics (also called “disease-modifying therapy” or “immunomodulators”) are a relatively new treatment option for people with moderate to severe psoriasis. They are given this name because they are derived from human or animal proteins instead of chemicals like most other medications.

Biologics work by targeting specific parts of the immune system, such as T cells or TNF, a chemical used to transmit messages between immune cells. This focused approach reduces the likelihood of side effects seen with medications that affect the entire immune system.

Biologics must be administered by injection, either into the skin (subcutaneously), into the muscle (intramuscular or IM), or by intravenous infusion (IV). Subcutaneous injections are similar to the insulin shots used by someone with diabetes and can be administered by the person with psoriasis or a caregiver.

Some biologics may require long-term use to keep psoriasis under control. Stopping treatment can lead to a premature return of symptoms.

Currently, five biologic medications are FDA-approved for psoriasis:

* Amevive (alefacept)
* Enbrel (etanercept)
* Humira (adalimumab)
* Remicade (infliximab)
* Stelara (ustekinumab)

Amevive (alefacept) works by blocking the activation of a type of white blood cells called T cells. This reduces inflammation and slows the excessive growth of skin cells.

Enbrel, Humira and Remicade work by blocking TNF-alpha, a chemical signal of the immune system, called a “cytokine.” Cytokines are involved in regulating the body’s inflammatory response. Blocking the TNF-alpha slows down the underlying inflammation within the skin of people with psoriasis.

Presently, all biologics used for psoriasis must be injected. They cannot be taken by mouth because the protein molecules are too large to be absorbed by the intestine or are too fragile to withstand the stomach acid.

Biologics should not be used by people who are immunocompromised or have an active infection. People 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 be prescribed to pregnant or nursing women if there is a clear medical need.

All of the biologics can be used in combination with other treatments, such as phototherapy or topical medications. The use of phototherapy with Amevive may improve the outcome. However, using phototherapy with Remicade may increase your risk of developing skin cancer. Enbrel, Humira, and Remicade are shown to be safe and effective when taken with methotrexate.

For more information about psoriasis, please visit the National Psoriasis Foundation or PsoriasisNet provided by the American Academy of Dermatology.