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Communicate promptly with your provider with any health related questions or concerns.

 

Biologics: for Psoriasis

Biologics are among the newer treatments for psoriasis and have become an important treatment option for people with moderate to severe psoraisis that has not responded to other therapies.

In the last decade, the Food and Drug Administration (FDA) has approved several biologics for the treatment of plaque psoriasis and psoriatic arthritis. There are currently five biologics approved for psoriasis: Amevive® (alefacept), Enbrel® (etanercept), Humira® (adalimumab), Remicade® (infliximab), and Stelara® (ustekinumab).

Most medications are synthesized from chemicals. Biologics, however, are derived from natural proteins found in living cells. Currently, all biologics used for the treatment of 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 work by targeting the underlying cause of psoriasis — excessive skin cell growth due to an overactive immune system. Although they can often provide long periods of clear skin, they are not a cure for psoriasis and ongoing treatment remains necessary.

How Do Biologics Work?

Immune system cells, such as T cells and B cells, monitor the body for bacteria, viruses and other infections. When these immune cells encounter a foreign substance, they release chemical signals, such as tumor necrosis factor (TNF) and interleukins, that trigger inflammation.

In people with psoriasis, the immune system mistakenly activates T cells that travel to the skin and produce excessive amounts of inflammation. This results in rapid skin cell growth and the development of psoriatic lesions.

Biologics inhibit the immune system, reduce inflammation and inhibit the excessive skin cell growth. Different biologic medications target different portions of the immune system. Some biologics reduce T cell activity, while others reduce the production of tumor necrosis factor (TNF) or interleukins.

A doctor may recommend the use of a biologic for people whose psoriasis is moderate to severe, cannot be controlled effectively with other psoriasis treatments, or cannot tolerate other psoriasis medications because of side effects.

Amevive® (alefacept)

Amevive® blocks the action of T cells to reduce inflammation and inhibit skin cell overgrowth. This leads to a clearing of lesions and other psoriasis symptoms. The medication is given by intramuscular (IM) injection, usually in the doctor's office.

A typical course with Amevive® is one intramuscular injection per week for twelve weeks, followed by additional 12-week treatment cycles if necessary. Treatment cycles must be separated by 12 week periods off treatment.

Blood tests are performed regularly to monitor T-cell counts.

Each doctor may tailor the use of Amevive according to how well someone responds to treatment and tolerates the medication.

Enbrel® (etanercept)

Enbrel® is FDA approved for the treatment of psorias, psoriatic arthritis and rheumatoid arthritis. It works by inhibiting the activity of TNF (tumor necrosis factor), the chemical “messenger” that triggers inflammation. Enbrel® is given as a subcutaneous injection (under the skin) similar to the insulin used by people with diabetes. People can learn to administer subcutaneous injections themselves at home.

A typical treatment course with Enbrel® is two subcutaneous injections per week for three months. A weekly maintenance dose may be recommended. Symptoms often return within a month or longer after stopping the medication.

Enbrel® may be used alone or in combination with other psoriasis medications, including methothrexate.

Blood tests may be performed to monitor the immune system during therapy with Enbrel®.

Each doctor may tailor the use of Enbrel according to how well someone responds to treatment and tolerates the medication.

Humira® (adalimumab)

Humira® has been prescribed for rheumatoid and psoriatic arthritis and was FDA-approved for the treatment of psoriasis in 2008. Like Enbrel®, Humira® helps clear psoriasis by interrupting the activity of TNF (tumor necrosis factor).

Humira® is given as a subcutaneous injection (under the skin) similar to the insulin used by people with diabetes.

A typical treatment course with Humira® is one subcutaneous injection every two weeks. These injections are given on an ongoing basis to relieve symptoms and stave off future outbreaks.

Humira® may be used alone or in combination with methotrexate or phototherapy.

Patients should be screened for latent tuberculosis (TB) before taking Humira®. Blood tests may be performed to monitor the immune system.

Each doctor may tailor the use of Humira according to how well someone responds to treatment and tolerates the medication.

Remicade® (infliximab)

First used as a treatment for psoriatic and rheumatoid arthritis, Remicade® is also FDA-approved for the treatment of moderate to severe psoriasis. Like other biologics used for the treatment of psoriasis, Remicade® works by blocking the action of TNF.

Remicade® is administered via IV (intravenous) infusion in a doctor's office or infusion center.

It is commonly administered three times in six weeks, and then once every eight weeks.

Remicade® may be used alone or in combination with methotrexate.

Patients should be screened for latent tuberculosis (TB) before taking Remicade® and regular blood tests may be performed.

Each doctor may tailor the use of Remicade according to how well someone responds to treatment and tolerates the medication.

Stelara™ (ustekinumab)

Stelara™ was FDA approved for the treatment of psoriasis in 2009. It works by blocking interleukin-12 and interleukin-23, immune-system proteins linked to inflammation and the rapid skin cell growth underlying psoriasis.

Stelara™ is usually given by injection twice in the first month, and then every 12 weeks. This results in approximately 5 treatments per year. The relatively low number of injections and long duration between treatments are considered to be some of the benefits of Stelara™.

Although other biologic medications may be self-injected at home, Stelara™ should be administered by a medical professional.

Patients should be screened for latent tuberculosis (TB) before taking Stelara™ and blood tests may be performed to monitor the immune system.

Each doctor may tailor the use of Stelara according to how well someone responds to treatment and tolerates the medication.

Insurance Coverage and Reimbursement

Biologics prescribed for the treatment of psoriasis are not always covered by health insurance. It is important to check with your health insurance carrier to see if and how biologics are covered. Some insurance companies offer partial coverage, require prior authorization, or work only with certain pharmacies through mail-order programs. Also, some biologics manufacturers provide information on how to work with insurance companies and offer reduced-cost medication for qualifying patients.

Where can I learn more about biologics for psoriasis treatment?

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© 2010 Vivacare. Last updated July 26, 2010

This information is for general educational uses only. It may not apply to you and your specific medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional. Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

Additional Resources

Conditions
Psoriasis Basics
Treatment Summary
Psoriasis Treatment
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