Biologics for Psoriasis

When Howard Chang, 50, first learned about biologic treatments for psoriasis almost 20 years ago, he was eager to give them a try. Now they’re a mainstay in his overall treatment plan.

Chang was first diagnosed with psoriasis around age 8. He tried lots of different treatments, including tar, phototherapy, topical creams and ointments, steroids, and oral medications.

“I definitely was always looking for the next new treatment, given that it was so hard for me to find anything that was effective,” Chang says.

He hoped biologics would provide much needed relief.

What Are Biologics?

Biologic drugs — often called biologics or biologic medications — work by changing parts of your immune system. You usually give yourself a shot. But some are given through an IV at your doctor’s office. The FDA approved the first two biologics for psoriasis in 2003. Now there are several options.

They’re generally prescribed for people with moderate to severe psoriasis, based on the amount of skin affected. But doctors also consider how psoriasis impacts a person’s life when deciding, says Malini Fowler, MD, a board-certified dermatologist in San Antonio, TX.

“There is no cookie-cutter candidate,” Fowler says. “Even if someone has mild disease, they are still probably a candidate for biologics, depending on how it affects their life.”

These drugs might also do more than just clear up your skin. They could help protect your heart, joints, and other body parts from inflammation.

“When we talk about using biologics, it’s a systemic medication treating (people) from the inside out, decreasing psoriasis on the skin, and hopefully helping with inflammation on the inside, too,” Fowler says.

What Are the Pros and Cons of Biologics?

Chang read up on how the drugs work, possible side effects and the risks when first considering biologics.

“Putting something in your body via an injection is something you have to think about, especially how it’s affecting your immune system,” Chang says.

Next, he spoke to his dermatologist.

“It’s key to have a dermatologist who understands the medications and also collaborates and connects with me as a (person),” Chang says. “We work on a plan together.”

While biologics can ease psoriasis symptoms, there are potential dangers, like with any drug. Some of them can up your odds for inflammatory bowel disease and cancer.

“You need to check if you have underlying cholesterol or hypertension problems,” Fowler says.  “Every biologic medicine is slightly different; most of them have a different mechanism of action with different safety profiles.”

It’s important to tell your doctor about any other conditions you may have, so they can make sure the biologic won’t interfere with them or any medications you take.

Which Biologic Is Most Effective for Psoriasis?

Chang has tried six biologic drugs since 2003. One helped for about 8 years, but he had to switch up the rest because he couldn’t tolerate the side effects of some drugs, they stopped working after a certain period of time, or they just didn’t work at all.

While Chang says he knows many people who have achieved healthier skin with biologics, treatment hasn’t been as successful for him.

“I’ve never really been clear,” he says. “It’s not a cure. There are still triggers that can cause a flare.”

Finding a biologic that works for you can be emotionally draining.

“It’s a roller coaster ride. You keep hoping it’s going to work, and you wait for it to kick in. And then if it doesn’t work for you, it can be a big letdown,” Chang says. “Especially since [psoriasis] has such a big impact on my life. Sometimes, I feel like I can’t fully function because I have all of this physical discomfort when I’m running, working, teaching, meeting with people. I just want to be comfortable.”

Fowler likes to give a biologic 3 months to run its course.

“Not every medicine is going to work for every (person), but it’s also important to stick with the medications and give them a chance to see if they help,” she says. “I tell (them), ‘If this doesn’t work, we’ll go on to the next one. We will find the right medicine for you, but it may be a bit of trial and error’.”

Can I Take Biologics With Other Treatments?

Chang continues to use other psoriasis treatments, including topical creams and phototherapy.

“I feel better about things overall [with biologics], that I don’t have to do everything perfectly,” he says. “It feels a little better to know I have a medication that is working in the background.”

And he knows that managing stress, exercising, and eating healthy are critical to keeping flare-ups at bay. They do the same for metabolic syndrome, a group of conditions linked to stroke, type 2 diabetes, and heart disease. People with psoriasis have a higher risk of metabolic syndrome.

In addition to regular appointments with a dermatologist while on biologics, Fowler suggests keeping your primary care doctor in the loop, getting blood work done every year, and seeing a rheumatologist every 6 months.

“I also routinely ask patients about joint pain, because about 30% [of people with psoriasis] will develop psoriatic arthritis,” she says.

What’s Most Challenging About Taking Biologics?

One of the hurdles is learning how to inject the medications yourself.

“I think I’ve self-injected myself over a thousand times,” Chang says.

Luckily, the number of injections is significantly lower with newer biologic medications. Chang says he used to have to inject himself two times a week, but some injections can now be weeks or months apart, depending on the medication.

Chang came up with a routine to follow when giving himself an injection, from washing his hands and setting out all the materials, to ensuring he has something to watch in the background.

“It calms me to have a routine,” Chang says. “[Injecting yourself is] something you never completely get used to, but you get more skilled at.”

Another hurdle can be getting approval from your insurance company to cover different biologics.

Chang is hopeful that the biologic treatments for psoriasis and other options will continue to improve.

“It’s just a time to be really optimistic as someone living with psoriasis,” he says. “With all the research, medications, and advocacy, we have options and more coming.”