Psoriasis is a chronic autoimmune disease that causes skin cells to grow too quickly, leading to thick, scaly patches on the skin. This condition develops when the immune system mistakenly attacks healthy skin cells, triggering inflammation and accelerating skin cell turnover. Biologics are specialized medications that directly target specific components of the immune system involved in the disease process.
What Are Psoriasis Biologics
Biologics are a distinct class of medications derived from living organisms, such as human, animal, or microbial cells. Unlike traditional systemic medications that broadly suppress the entire immune system, biologics are designed to interfere with specific steps in the immune process that contribute to psoriasis symptoms. They achieve this by targeting particular proteins or cells involved in inflammation. This targeted approach helps to reduce the widespread inflammation and rapid skin cell production characteristic of psoriasis. Biologics are often referred to as biologic therapies or biological response modifiers due to their ability to modify how certain body systems respond.
How Biologics Target Psoriasis
Psoriasis involves an overactive immune system, where certain immune cells and signaling proteins, called cytokines, are produced in excess. These cytokines drive the inflammatory process and the accelerated growth of skin cells. Biologics work by selectively blocking these specific immune system components to interrupt the disease cycle. For example, some biologics target tumor necrosis factor-alpha (TNF-alpha), a cytokine that promotes inflammation and rapid skin cell growth in psoriasis and psoriatic arthritis. Other biologics focus on interleukins, such as IL-12, IL-23, and IL-17, which are also involved in stimulating inflammation and skin cell proliferation. By inhibiting these specific pathways, biologics help to normalize the immune response and reduce the visible symptoms of psoriasis.
Types of Biologics and Administration
Several categories of biologics are available for psoriasis, each targeting different immune pathways. TNF-alpha inhibitors include medications like adalimumab, etanercept, and infliximab. IL-17 inhibitors, such as secukinumab, ixekizumab, and brodalumab, specifically block the IL-17 cytokine. IL-23 inhibitors, like guselkumab, risankumab, and tildrakizumab, target the IL-23 pathway. Ustekinumab targets both IL-12 and IL-23.
Biologics are administered either through subcutaneous injections or intravenous (IV) infusions. Subcutaneous injections can be self-administered at home, with guidance from a healthcare provider. Intravenous infusions are administered at a clinic or hospital. The frequency of administration varies, ranging from weekly or bi-weekly injections to infusions given every few months.
Eligibility and What to Expect
Biologics are prescribed for individuals with moderate to severe psoriasis or psoriatic arthritis, particularly when other treatments have not been effective or have caused unwanted side effects. Before starting biologic therapy, medical tests are required, including screening for tuberculosis and other infectious diseases, because these medications can affect the immune system.
The benefits of biologics can be significant, with many patients experiencing reduction in symptoms, including skin clearing and relief from joint pain and stiffness in psoriatic arthritis. This often leads to improved quality of life.
Potential side effects of biologics include an increased risk of infection, such as respiratory infections, and the possibility of reactivating latent infections like tuberculosis. Injection site reactions are also common. Regular monitoring by a healthcare provider is important to manage any potential side effects.
Biologic medications are expensive, with annual costs that can range from tens of thousands of dollars to over $100,000. Insurance coverage requires patients to try other therapies first before approving biologics. Patient assistance programs and manufacturer copay cards are available to help offset these costs for eligible individuals.