What Is The Best Biologic For Psoriasis

Identification Of Studies And Data Extraction

We searched the PubMed, Cochrane Central Register of Controlled Trials , and EMBASE databases from inception to 7th October 2017 for relevant studies. To increase the sensitivity of search, we also used snowball method, i.e. we scanned the references list of included studies to see if there were other relevant studies. We used the following terms in searching electronic databases: drug retention or drug survival or drug persistence and psoriasis. Studies that analyzed the drug survival of biologics and reported the respective annual data for each biologic for at least 1 year were included. Studies that did not report the respective survival of biologics or did not have outcome data for at least 1 year were excluded.

We scanned the titles and abstracts of the search results and obtained the full text of potentially eligible studies for further evaluation. Two investigators independently screened, selected relevant studies, and used the NOS to assess the risk of bias of included studies. A third author was available for arbitration when discrepancy occurred. We did not impose any language restrictions.

Skyrizi Is A Biologic That Was Approved For The Treatment Of Moderate

What is Skyrizi?

Skyrizi was approved by the FDA in April 2019 for the treatment of moderate-to-severe plaque psoriasis in adults. Skyrizi was approved by the FDA in January 2022 for the treatment of active psoriatic arthritis in adults.

For both plaque psoriasis and PsA, Skyrizi is given by injection under the skin at week 0 and week 4, and then every 12 weeks afterwards.

To learn more, please visit the Skyrizi website.

Ustekinumab Injection May Cause Side Effects Tell Your Doctor If Any Of These Symptoms Are Severe Or Do Not Go Away:

• headache

• swelling of the face, eyelids, tongue, or throat
• difficulty breathing
• tightness in the chest or throat

Ustekinumab injection may increase the risk that you will develop cancer. Talk to your doctor about the risks of using this medication.

Ustekinumab injection may cause other side effects. Call your doctor if you have any unusual problems while using this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administrations MedWatch Adverse Event Reporting program online or by phone .

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What Should People Know About Self

A person can self-inject nearly every biologic on the market in the comfort of their own home. Many companies also provide nursing support, which involves a nurse visiting the persons home to teach them to self-administer injections.

Most of the medications are administered through auto-injector pens, rather than traditional syringes, to ease the process. In some cases, people can still go to their doctors office for the injections, if they are not comfortable administering them at home.

The first step is to thoroughly clean the hands and the site of the injection. An injection should only take place in an area that is not affected by psoriasis.

Place the auto-injector flush to the skin, then press the releaser to deliver the medication. Do not lift the auto-injector from the skin until the dose has been fully administered.

Then, clean the skin again if there is a drop of blood, and apply an adhesive bandage.

Biologics For Psoriasis: What To Consider

Biologics, or biologic drugs, are types of medications that are made from living organisms. This is why they are called biologics bio means life.

They can be made from human or animal cells and bacteria and other microorganisms. For example, vaccines are a type of biologic.

Biologics have proteins that target specific cells inside your body and affect the immune system by interfering with the inflammatory process. For this reason, biologics are used to treat autoimmune skin conditions like psoriasis.

In 2013, it was estimated that around 7.4 million people in the United States have psoriasis.

There are several treatment options for psoriasis, including topical treatments, prescription drugs, and phototherapy. If you have moderate to severe psoriasis and your current treatment isnt working, it may be time to think about trying biologic drugs.

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Table 2 How And When To Take A Biologic Drug

Some of the biologics have multiple uses and are also approved for treating other diseases such as ankylosing spondylitis, Crohns disease, rheumatoid arthritis, ulcerative colitis, and other autoimmune diseases.

Can Biologics Be Combined With Other Treatments

The use of a single drug or a single therapy method may not work for everyone with psoriasis. If single drugs arent working for you, or arent working as well as they once did, it may be time to consider combining biologics with other treatments for psoriasis.

There are three main benefits of using a combination approach:

• It can decrease the possibility of reaching toxic levels with a single drug.
• The individual drugs can be prescribed at a lower dose.
• A combination approach can be more successful than a single treatment option.

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Tips For Overcoming Your Hesitation

Biologics arent new. The first biologic for psoriasis was approved in 2003. Over the last couple decades, researchers have gathered quite a bit of evidence to support the safety and effectiveness of these medications.

You may be hesitant to talk with your doctor about biologics because youve heard theyre stronger drugs. Or perhaps youre worried theyre too expensive.

Its true that biologics are considered a more aggressive treatment option. They also have a high price point. But theyre more targeted drugs, which means they work very well. And they tend to have fewer side effects than other psoriasis treatments.

Still, you shouldnt take a biologic if:

• your immune system is significantly compromised
• you have an active infection
• you recently received a live vaccine such as shingles, MMR , or flu mist
• youre pregnant or nursing

If youre afraid of needles, ask your doctor about a new treatment for psoriasis known as apremilast . Otezla is taken as a pill twice per day. It isnt considered a biologic. Rather, its in a new class of drugs known as PDE4 inhibitors. Otezla is FDA-approved to treat moderate to severe plaque psoriasis when phototherapy or systemic therapy is appropriate.

Will Any New Biologics Being Developed Get Us Closer To A Cure For Psoriasis

While researchers are currently evaluating new biologics, it will be several years before they become available.

The good news is that the options available are providing safe and effective results. We can confidently say that the current medications can lead to 90100% clearance of symptoms in people with psoriasis.

Joshua Zeichner, MD, is the Director of Cosmetic and Clinical Research in Dermatology at Mount Sinai Hospital in New York City. He actively lectures to international audiences and is involved in daily teaching of residents and medical students. His expert opinion is commonly called upon by the media, and he is regularly quoted in national newspapers and magazines, such as The New York Times, Allure, Womens Health, Cosmopolitan, Marie Claire, and more. Dr. Zeichner has been consistently voted by his peers to the Castle Connolly list of New York Citys best doctors.

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Sticking To Your Treatment Plan

Treating PsA takes a lot of work, and it can be hard to keep up with all the aspects of your care. The Psoriasis Foundation says the main reason PsA treatments fail is that people don’t stick to them properly.

Biologic therapy comes with some challenges, including high costs, fear of side effects, not feeling better quickly enough, or the timing of treatment might be inconvenient. It is also not uncommon for people to feel wary of biologics.

But your healthcare provider has prescribed biologic drug therapy because they have determined the benefits outweigh the risks. And, fortunately, most of the newer biologics are effective and safe to use.

Stopping treatment, regardless of the reason, is never a good idea. You will likely find yourself with increased PsA symptoms and flares as soon as you stop using your biologic or other treatments. The decision to stop or reduce treatment should be made between you and your provider.

Who Can Take Biosimilars

All biologics, including biosmilars, are typically prescribed for people with more advanced disease, including individuals with moderate-to-severe psoriasis and active PsA. But each of the three approved biosimilars are indicated for different groups within this population.

You should not take biosimilars if:

• Your immune system is significantly compromised
• You have an active infection

Screening for tuberculosis or other infectious diseases is required before starting treatment with all biologics, including biosimilars.

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Biologics Are Expensive But You Likely Wont Pay All Of It Out Of Pocket

Biologics can cost between $10,000 and $30,000 per year, and potentially up to $500,000 for the most expensive options. Most insurance companies cover at least a portion of that, but how much youll pay out of pocket and which drugs are covered depends on your insurance plan.

If you cannot afford the biologic youre prescribed, talk to your doctor or pharmacist about your options. Your state may have a drug plan to assist with medication costs. You can also check the drug manufacturers website for their patient assistance program : You might qualify for lower co-pays or even be able to get the medication free.

Your Psoriasis Is Mild But Really Bothers You

Biologics are typically reserved for those with moderate to severe psoriasis, but they could be an option if your psoriasis is greatly affecting your quality of life.

Even if your psoriasis is considered mild, you may have painful plaques on the soles of your feet, your palms, your face, or your genitals. The pain may prevent you from doing your usual activities. In these cases, a switch to a biologic may be justified.

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Acrodermatitis Continua Of Hallopeau

This type of pustular psoriasis is rare. It causes pus-filled bumps on the fingertips, toes, or both. The disease can also develop underneath the nails.

Often beginning on one finger or toe, new pus-filled bumps may continue to appear. When this happens, new pustules can develop on more than the fingers and toes. In rare cases, the pus-filled bumps can slowly spread up the arms or legs.

Anyone who has pus-filled bumps over much of the skin needs immediate medical care. When widespread, pustular psoriasis can be life-threatening.

The first choice for treating this type of pustular psoriasis often includes the following.

• Synthetic vitamin D combined with a strong corticosteroid: This combination is applied to the skin.

• PUVA: This is a type of light treatment that involves taking a medication called psoralen before getting UVA light treatments on the affected skin.

While the above describes what treatment may be used for each type of pustular psoriasis, your treatment plan may include different medications. Your age, other medical conditions , and general health also play key role in determining which treatment is best for you.

ImageGetty Images

ReferencesFitzpatrick JE. Pustular eruptions. In: Fitzpatrick JE and Aeling JL. Dermatology Secrets. Hanley & Belfus, Inc., Philadelphia, 1996:66-7.

Jeon C, Nakamura M, et al. Generalized pustular psoriasis treated with apremilast in a patient with multiple medical comorbidities. JAAD Case Rep. 2017 3: 495-7.

How Are Biological Agents Given For Psoriasis

All these biological medicines are given at defined intervals. The interval between doses is dependent on each individual biological medicine. Etanercept, alefacept and efalizumab are usually once weekly, and adalimumab is every two weeks by self-administered subcutaneous injection. Infliximab is given by intravenous infusion at a hospital or clinic, 3 times over a period of 6 weeks and then every 8 weeks.

In many cases, other topical and systemic medications for psoriasis may also be prescribed in an attempt to improve efficacy.

Biological medication is often very effective in psoriasis. However, in some cases, they lose their effectiveness after a period of time and other treatment may be required.

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How To Take And Store

Your biologic medication should be refrigerated before use. Remove your medication 30 minutes before the time that you are going to administer your injection so that the medication can reach room temperature.

Before you administer your injection, you should have an alcohol pad and sterile bandage ready. Wash your hands with soap and water, and swab the skin where you will administer the injection with an alcohol pad to cleanse the skin and reduce the risk of infection.

The frequency of injections depends on the specific type of medication that you are prescribed. Remicade is delivered intravenously through insertion of an IV into a vein and repeated every eight weeks.

All the other types of biologic medications are injected subcutaneously, or under the skin, most commonly in your abdomen or thigh. Some medications require a frequent injection schedule, such as Enbrel every week and Humira, Siliq, and Cimzia every other week.

Other medications require less frequent injections after the initial dose, such as Cosentyx and Taltz every four weeks, Simponi once a month, Tremfya every eight weeks, and Skyrizi and Stelara every 12 weeks.

It is important to follow your dosing regimen as missed doses can reduce the effectiveness of your biologic medication.

Table 1 Biologic Drugs Used To Treat Psoriasis

Read about Biologic Drugs Used to Treat Rheumatoid Arthritis.

All of the biologics are given by injection. As Table 2 shows, one of them is given through a vein in your arm , while the others are injected under the skin .

How often you have to take a biologic will depend on which drug you take. Some are given once a week or every other week, some once a month or every three months, and others have a more varied schedule. Discuss with your doctor whether you feel comfortable injecting yourself or whether you prefer an intravenous infusion at your doctors office.

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What Are The Risks Of Biosimilars

The risks and side effects of biosimilars are the same as those associated with their biologic reference product. Anyone considering taking a biosimilar should talk with their health care provider about the short- and long-term side effects and risks. It is important to weigh the risks against the benefits.

Biologics and biosimilars act on cytokines, which are specific proteins released by the immune system that can cause inflammation. Biologics suppress the function of the overactive immune system. When on a biologic or biosimilar, you may have a higher risk of infection. If you develop any signs of an infection, contact your health care provider right away.

Signs of infection include:

• Damp, sticky feeling or sweating
• Fever

Why Is This Medication Prescribed

Ustekinumab injection is used to treat moderate to severe plaque psoriasis in adults and children 6 years or older who may benefit from medications or phototherapy . It is also used alone or in combination with methotrexate to treat psoriatic arthritis in adults. Ustekinumab injection is also used to treat Crohns disease in adults. Ustekinumab injection is also used to treat ulcerative colitis in adults. Ustekinumab injection is in a class of medications called monoclonal antibodies. It works by stopping the action of certain cells in the body that cause the symptoms of plaque psoriasis, psoriatic arthritis, Crohns disease, and ulcerative colitis.

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How Well Do The Biologic Drugs Work To Relieve Arthritis Caused By Psoriasis

All six biologic drugs included in our analysisadalimumab , certolizumab , etanercept , golimumab , infliximab , and ustekinumab are FDA-approved to treat psoriatic arthritis. The biologic drugs reduce joint pain and inflammation and improve the quality of life in up to 80 percent of people with this condition.

There are no head-to-head trials of biologic drugs to treat arthritis caused by psoriasis. Other studies that attempted to compare them indirectly had mixed results, but most found no difference in effectiveness among Humira, Enbrel, and Remicade. Simponi was approved after these studies were done. In the only major study of Simponi, about half of people who received it had at least a 50 percent improvement in joint pain, swelling, and function.

Cosentyx Is A Biologic That Was Approved For The Treatment Of Psoriasis In 2015 And For The Treatment Of Psoriatic Arthritis In 2016

What is Cosentyx?

Cosentyx was approved by the FDA for the treatment of moderate-to-severe plaque psoriasis in adults in January 2015 and approved for use in children 6 years and older in June 2021. In January 2016, the FDA also approved Cosentyx to treat adults with active psoriatic arthritis.

For patients with plaque psoriasis, Cosentyx is administered by injection under the skin at weeks 0, 1, 2, 3, and 4 and then every 4 weeks. Health care providers may recommend a different dosing schedule for patients with psoriatic arthritis.

To learn more, please visit the Cosentyx website.

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Best Biologic For Scalp Psoriasis

Such over-the-counter tar shampoos can help reduce scalp pruritus.

The new class of biologic therapies for psoriasis, including etanercept, efalizumab, and alefacept, have received significant.

How Do I Know If I Have Scalp Psoriasis? The Best Psoriasis Shampoos What Else Can I Do To Manage Scalp Psoriasis? Plenty of Americans deal with occasional dandruff, dryness and itchiness on their.

Excellence in Ethnic Skin Care Dermatology. Please take a look at just a few of the success stories below and we think that you will agree that African American dermatologist Dr. Charles E. Crutchfield III is one of the worlds premier experts in the treatment of ethnic skin concerns including cosmetic skin care for African American dermatology, Asian and Hispanic skin patients.

Scalp Psoriasis vs. Dandruff: How to Know Whats Causing Those White Flakes These medications and biologics have side effects, which your dermatologist can explain and help you consider if theyre a good option for you. Another concern among those with scalp psoriasis is.

Psoriatic skin lesions typically appear symmetrically on the scalp, trunk, and limbs but may also affect the genitals.

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Plaque psoriasis. Scalp psoriasis. Inverse psoriasis. Pustular psoriasis. Nail psoriasis. Once inside, biologics zone in on.

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The main side effects that biologics can cause include infections and malignancies. While reducing inflammation in the skin is good for.

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