Moderate to severe psoriasis: biologic drugs

Biologic drugs, or "biologics," are a relatively new class of treatment for psoriasis and psoriatic arthritis treatments. They are given by injection or intravenous (IV) infusion.

A biologic is a drug or vaccine that comes from living sources, such as human or animal proteins. Biologics have been around for more than 100 years. However, they have been used only in the decade for psoriasis and psoriatic arthritis. 

Different from the traditional systemic drugs that impact the entire immune system, biologics target specific parts of the immune system. Biologics act by blocking the action of certain immune cells—either T cells or tumor necrosis factor-alpha (TNF-alpha)—that play a major role in psoriasis and psoriatic arthritis.

T-cell blockers

Amevive (alefacept) and Raptiva (efalizumab) work by blocking the activation of a type of white blood cells called T cells and reducing inflammation. T cells help the body rid itself of foreign invaders such as viruses, fungi and bacteria. Psoriasis activates T cells, which then travel to the skin. Once in the skin, they respond as though they were fighting an infection or healing a wound. This sets off a chain or "cascade" of events that causes psoriasis lesions to form and become inflamed.

On April 8, 2009, Genentech, Inc. announced a phased voluntary withdrawal of Raptiva from the U.S. Market; the drug will no longer be available after June 8, 2009.

Tumor necrosis factor-alpha (TNF-alpha) blockers

Enbrel (etanercept), Humira (adalimumab) and Remicade (infliximab) are drugs that block TNF-alpha. TNF-alpha is type of cytokine of the immune system that causes cells to release proteins, contributing to inflammation. In psoriasis and psoriatic arthritis, there is excess production of TNF-alpha in the skin or joints. This can leads to the rapid growth of skin cells typical of psoriasis, or to the joint inflammation in psoriatic arthritis. Blocking the TNF-alpha helps to stop the inflammatory cycle of psoriatic diseases.

How are they used?

The biologics are taken by injection or by IV infusion. Amevive is administered by intramuscular injection in a medical office. Enbrel, Humira and Remicade are injected in the legs, abdomen or arms, typically by the individual with psoriasis or a family member. Remicade is given through IV infusion in a doctor’s office or infusion center.

Biologics are prescribed for individuals with moderate to severe cases of psoriasis and psoriatic arthritis. They are a viable option for those who have not responded to or have experienced harmful side effects from other treatments. Enbrel, Humira, and Remicade are shown to reduce the progression of joint damage in psoriatic arthritis also.

Do not take biologics if:

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

Screening for tuberculosis (TB) or other infectious diseases is required before starting treatment with Enbrel, Humira or Remicade.

What are the risks?

Anyone considering taking a biologic drug should talk with his or her doctor about the short- and long-term side effects and risks. It is important to weigh the risks against the benefits of using the drugs.

Biologics can increase the risk of infection. Individuals who develop any sign of an infection such as a fever, cough or flu-like symptoms or have any cuts or open sores should contact their doctor right away.

The impact of biologics on a developing fetuses or nursing infants is not known. Biologics should be prescribed to pregnant or nursing women if there is a clear medical need.

 Common side effects for biologics include:

• Respiratory infections
• Flu-like symptoms
• Injection site reactions

These side effects are generally mild and in most cases do not cause individuals to stop taking the medication.

Rare side effects for biologics include:

• Serious nervous system disorders, such as multiple sclerosis, seizures, or inflammation of the nerves of the eyes have;
• Blood disorders;
• Certain types of cancer.

Call your doctor if you are experiencing any side effects with biologic drugs. For specific side effect information, download the individual product fact sheet.

Using biologics with other psoriasis treatments

All of the biologics currently on the market can be used with other treatments such as phototherapy or topicals. There is data that suggests that phototherapy in combination with Amevive may improve the outcome. Using phototherapy along with Remicade may increase your risk of skin cancer. Avoid phototherapy while on Raptiva unless directed by your doctor.  

Enbrel, Humira, and Remicade are shown to be safe and effective when taken with methotrexate. Talk to your doctor about whether using any other treatments with a biologic is right for you.

For more information on individual biologic treatments download a product fact sheet.