Biological treatment of psoriasis – who is eligible, positives, negatives

Psoriasis is an autoimmune inflammatory disease. The immune system of a psoriatic person excessively accelerates the production of skin cells (keratinocytes). While for an average person, skin cells renew approximately every 28 days, in a psoriatic individual, it is every three to six days.

The accelerated production of keratinocytes leads to thickening and scaling of the skin. That manifests as red and thickened skin (alongside inflammation).

The therapeutic goal of psoriasis treatment is to regulate the immune system – to slow down the multiplication of skin cells and to suppress inflammation. If we suppress the immune system indiscriminately, we partially weaken an important barrier that protects us from the dangers of the surrounding world, such as infectious microorganisms.

A person with a weakened immune system is more susceptible to infections, inflammations, blood disorders, digestive difficulties, as well as autoimmune diseases and cancer.

You can learn more about biological drugs and the difference between conventional and biological medications in this article.

Biological therapies for psoriasis belong to monoclonal antibodies. These are naturally occurring protein molecules in the body that have the ability to selectively bind to a structure (antigen) on the surface of a cell and thus initiate an effect (send a signal), or conversely, simply block a specific site so that another molecule cannot bind to it (block the signal).

• Adalimumab – TNF-α blocker,
• Etanercept – TNF-α blocker,
• Infliximab – TNF-α blocker,
• Certolizumab pegol – TNF-α blocker,
• Guselkumab – IL-23 blocker,
• Risankizumab – IL-23A blocker,
• Tildrakizumab – IL-23A blocker,
• Ustekinumab – IL-12 and IL-23 blocker,
• Secukinumab – IL-17A blocker,
• Ixekizumab – IL-17A blocker,
• Brodalumab – IL-17RA blocker,
• Bimekizumab – IL-17A, IL-17F, and IL-17AF blocker. *

*The mentioned medications are used to treat plaque psoriasis. The list may not be up-to-date, as the segment of biological drugs is rapidly growing. IL – interleukin, TNF – tumor necrosis factor.

Almost all biological drugs for psoriasis are monoclonal antibodies (recognized by the suffix -mab in their names). Etanercept is also a biological medication, but it belongs to a class known as fusion proteins.

Molecules TNF-α, IL-12, IL-17, and IL-23 are pro-inflammatory proteins (cytokines) that participate in inflammatory processes in our bodies. By selectively blocking them, we achieve a reduction in inflammation, which is the main cause of difficulties in psoriasis.

Safety

Biological drugs are generally safe precisely because of their selective effects. By targeting the mechanism that triggers inflammation in psoriasis while leaving other components of the immune system untouched, we obtain an effective and, above all, safe medication.

Tolerance

With conventional systemic treatment for psoriasis, treatment discontinuation due to intolerance, contraindications, or severe side effects often occurs. Conversely, discontinuation of biological treatment due to adverse effects is rare.

The most common adverse effects of biologics are:

• reaction at the injection site (redness, itching, mild pain),
• allergic reactions,
• increased incidence of upper respiratory tract infections that tends to decrease over time.

Effectiveness

Biological treatment is the most effective therapy for psoriasis. Very often, in individuals with severe psoriasis with lesions throughout the body, complete or near-complete disappearance of skin symptoms is achieved. Significant improvement also occurs in the scalp area and on the nails, and joint pain alleviates as well.

Limitations

With biological treatment, there are practically no limitations in the patient's life. On the other hand, conventional systemic medications may cause sensitivity to sunlight, and blood parameters may need to be monitored during their use.

Dosage

Although biological treatment is almost exclusively administered through injections, it has to be applied every 2 to 12 weeks depending on the medication. An exception is etanercept, which is administered weekly. Many biologics come in the form of injection pens, which you can administer in the comfort of your home.

In contrast, conventional treatment is taken daily (acitretin, cyclosporine) or weekly (methotrexate).

Many people may perceive biological treatment as something new, perhaps not fully explored, and therefore may fear what it will do to their bodies in 20 to 30 years. Fear of the unknown is natural.

However, the truth is that the first biological drug of the monoclonal antibody type was approved as early as 1986, almost 40 years ago. The entry of a drug into the market is very well regulated and controlled nowadays. With each new drug, safety, efficacy, and quality must be demonstrated.

Biological treatment is the most effective therapy for psoriasis and many other conditions. Its wider application is hindered primarily by its cost. Therefore, if you are a suitable candidate for biological treatment, it is your best chance to suppress symptoms and improve your quality of life.

Read more about the steps you need to take before starting biological treatment.

You can also get more information from clinics specializing in biological treatment. You can find their list on this page.