Psoriasis patients benefit from long-established treatments
How to Treat Psoriasis with Biologics
There is no cure for psoriasis. Most individuals who have psoriasis take drugs that treat localized patches of psoriasis, but if your psoriasis is widespread or severe, you might try a new type of treatment called biologics. Biologics target only those specific cells and proteins of the immune system that contribute to the development of psoriasis. Treatment with biologics can minimize or prevent psoriasis recurrences, especially in people with moderate to severe cases of plaque psoriasis and psoriatic arthritis.Most people need biologics at regular intervals to maintain their results over time.You can treat psoriasis with biologics by receiving injections or intravenous (IV) infusion of biologic drugs, but in either case, a doctor must administer it to you.
Undergoing Biologic Injections or IV Infusions
Identify different biologics.Biologics are protein-based drugs derived from living cells cultured in a laboratory. There are a large number of biologics used to treat psoriasis. These drugs target different aspects of psoriasis. Your doctor will decide on your treatment based on your symptoms. Having an idea of what types of biologic your doctor may prescribe can help you understand your psoriasis treatment. Biologic drugs for psoriasis include:
- Drugs that block TNF-alpha, which leads to the production of excess skin cells. These include: Cimzia (certolizumab pegol), Enbrel (etanercept), Humira (adalimumab), Remicade (infliximab) and Simponi (golimumab). These can stop the rapid growth of skin cells and/or damage to joint tissue. They can also minimize inflammation and the inflammatory cycle of psoriasis.
- Interleukin 12/23, which blocks specific proteins associated with psoriasis. Stelara (ustekinumab) is the biologic most often used to block these proteins. These drugs can ease inflammation and stop the inflammation cycle.
- Interleukin 17-A, which binds and inhibits a protein that causes psoriatic inflammation as well as plaque psoriasis. The biologics used to block interleukin-17A are Cosentyx (secukinumab) and Taltz (ixekizumab). These drugs can relieve inflammation, stop the inflammatory cycle of psoriasis, and may improve your symptoms.
Get pre-treatment testing.Some individuals with psoriasis may not be ideal candidates for biologic treatments. Your doctor will prescribe blood tests to ensure that you don’t have any active infections, diseases, or a compromised immune system. Have these tests before you begin any to ensure that you get maximum benefit from biologics.
- Recognize that if your immune system is significantly compromised or you have active infections, you may not use biologics. In addition, individuals with infectious diseases, especially tuberculosis, may not be able to undergo treatment with biologics. Biologics may also not be suitable for individuals with cancer.
Receive or give yourself biologics injections.Most biologic treatments for psoriasis are administered by injection. You can either inject these drugs yourself on a regular basis or your doctor may do it for you. The most common injectable biologics are Cosentyx, Enbrel, Humira, Stelara, Cimzia and Taltz.
- Follow dosing instructions that your doctor provides. In general, you’ll get injections at regular intervals such as once every week or two weeks. Use injectable biologics continuously to maintain your results.
- Undergo additional blood testing while using injectable biologics to determine their effectiveness.
Have regular biologic infusions.Some biologic treatments for psoriasis are administered by intravenous infusion in a doctor’s office.The most common infusion biologic is Remicade.Like biologic injections, you’ll need infusions at regular intervals to maintain your results.
- Receive three infusions of Remicade during your first six weeks of treatment. After that, you’ll have repeat infusions every eight weeks.
- Recognize that Remicade may also minimize any progression of joint damage as a result of psoriasis.
Combine biologics with other psoriasis treatments.Your doctor may combine biologics with other psoriasis treatments, including oral and topical medications and phototherapy. Combination therapy can increase the effects of your treatment. This may be best way to ease your symptoms and prevent them in the future.
- Talk to your doctor about using a topical solution for treating small and localized areas with psoriasis.
- Try going out for short bursts of sun exposure a few times a day. Do not stay out too long in the sun, and avoid getting sunburned.Be aware that using phototherapy with Remicade can increase your risk of skin cancer.
- If your scalp is affected, you can try using tar shampoo for relief.
Watch for side effects.Like any medication, you may experience side effects from biologic treatments for psoriasis. These range from mild to severe and may include skin reactions and flu-like symptoms. Contact your doctor if you experience any of the following common and/ or rare side effects of biologics:
- Respiratory infections
- Flu-like symptoms
- Injection site reactions
- Seizures (rare)
Weighing the Benefits and Risks of Biologics
Speak to your doctor about your options.Before you try biologics, consider working with a functional medicine doctor to get to the root cause of your psoriasis. You may be able to make changes to your diet or lifestyle to treat your psoriasis. Biologics are best used to treat severe psoriasis that hasn’t responded to other treatments. Biologics may also be good for individuals who have had bad side effects from systemic treatments including oral medications.If you have had either of these experiences with other psoriasis treatment, ask your doctor if biologics are a good option for you.
- Let your doctor know why you’d like to try biologics. For example, “Dr. Gonzalez, these pills don’t seem to be working for me as well any longer and I keep having recurrent bouts of psoriasis. I read recently that there are newer treatments called biologics. Are these something that would benefit my psoriasis?”
- Ask your doctor about combining treatments or switching over only using biologics. You may want to discuss costs, including what insurance may cover and payment programs that some drug companies offer. Not all insurance companies cover biologics and other may require pre-authorization for treatments. Make sure to check with your insurance company before you undergo treatment with biologics.
Recognize the benefits of biologic treatments.Doctors have used biologic treatments for at least the last 100 years. However, new technologies and developments have made biologics much more widely available and effective.Some additional benefits of using biologics to treat your psoriasis include:
- Stopping the inflammatory cycle of psoriasis
- Decreasing plaque buildup
- Halting joint damage
- Reducing inflammation
Be aware of the risk factors of using biologics.Just as there are benefits to using biologic treatments for your psoriasis, you may expose yourself to risk as well. Recognizing the risks can not only help you and your doctor determine the best form of treatment, but also catch any potential issues before they become complications.
- Recognize that biologics can lead to rare side effects that include developing nervous system disorders such as multiple sclerosis, blood disorders, and certain types of cancer.
- Be aware of other risks including heart failure in patients with cardiovascular conditions, changes in blood pressure, difficulty breathing, and dizziness. You may even have abdominal discomfort or headaches.
- While biologics are effective, they are very expensive. Make sure that your insurance will cover this treatment.
- Let your doctor know if you are pregnant, may be pregnant, or are nursing. You should only undergo treatment for psoriasis with biologics if there is a clear medical need in these circumstances.
- Avoid using biologics if you have a severely compromised immune system or an active infection.
- Lithium, beta-blockers, and NSAIDS (such as ibuprofen) can worsen psoriasis. Talk to your doctor about reducing your dosage or finding a suitable replacement.
- If your immune system is compromised or if you have a current infection, do not use biologics.
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