Health Tips

Topic 4: Biologics for Psoriasis

Welcome to DOC2US Psoriasis Health Tips Section. Hope you liked our previous articles and let’s discuss more on psoriasis today.

There isn’t a one-size-fits-all approach when it comes to psoriasis management. Numerous clinical trials have been conducted to ensure that the treatments are backed up with scientific evidence to prove that they do work for most people.¹ With that, the introduction of biologics into the market for psoriasis has put in place many new possibilities for the management of psoriasis. Many people would describe biologics as a life-changing medication as they experienced improvements in their psoriasis condition when other therapies were not working for them.²

Image credit to Contract Pharma

Your attending physician may prescribe biologics medication if you are experiencing any of the following conditions:

1. Standard systemic therapies (oral medications such as methotrexate, ciclosporin, acitretin, or phototherapy) aren’t working for you³
2. You cannot tolerate or have contraindications to other psoriasis treatments³
3. You have moderate to severe psoriasis^3,4
4. Your quality of life is affected by psoriasis⁴

Based on findings from clinical studies, biologics have been found to be the latest treatment introduced into the market that are effective for moderate to severe psoriasis.³ Biologics are also recommended by international and local clinical guidelines such as American Academy of Dermatology Association (AAD) and MOH Clinical Practice Guidelines for the management of psoriasis.^2,3 You may refer to your attending physician for more information on biologics.

Biologics target specific parts of the immune system which cause psoriasis, making them an effective treatment option.

Psoriasis occurs when the immune system goes haywire, causing it to attack the healthy skin cells in the body.⁵ The body releases inflammatory proteins or chemical messengers that are responsible for the inflammatory response in psoriasis.^6,7,8,9 Biologics are specifically designed to mimic our immune system, allowing them to correct the malfunctioning system.¹⁰ They block these inflammatory proteins responsible for psoriasis, switching them off without affecting the whole immune system.^6,7,8,9

Living with psoriasis may affect your quality of life. Biologics, however, are able to help you improve the skin lesions and gain your functional recovery.

Biologics are able to improve the physical and psychological levels of those with psoriasis significantly.¹¹

With biologics, one can achieve improved psoriasis skin lesions, possibly achieving up to 100% improvement in Psoriasis Area and Severity Index and Dermatology Life Quality Index, which can really boost one’s self-esteem, allowing them to live a normal life.¹² Studies have shown that the use of biologics is associated with better skin appearance and higher confidence levels.¹¹ Improvements can be seen within 3 to 4 months depending on the type of biologics used.^6,7,8,9

A study conducted by Trettin et al. (2020) reported that biologics have given patients with psoriasis a new lease of life, making them feel more attractive, followed by a sense of achievement in gaining significant improvements in their symptoms.¹¹ It was a life-changing experience for them when they noticed how their skin gradually improved over time until the psoriasis become invisible.¹¹ They were able to regain control of their daily lives and return to society.¹¹

In addition, biologics are usually taken less frequently and this makes it more convenient.¹³ This helps to improve the patients’ compliance with their medications, which means, it will be easier for them to remember to take their medications on time. Some biologics need to be administered once a week, some once every few weeks, but some can be administered only once every 12 weeks.^6,7,8,9,13 With proper training, one can administer the medication safely themselves in the comforts of their homes.^6,7,8,9,13 Biologics may also help to prevent other health conditions associated with psoriasis such as psoriatic arthritis as biologics are very effective in reducing inflammation.¹⁴

What else do you need to know about biologics?

Biologics have fewer side effects as it works in a more selective way than other psoriasis treatments.¹³ They target specific proteins in the immune system that have been proven to be associated with psoriasis.¹³ Some of the common side effects associated with biologics are increased risk of infections, reactivation of tuberculosis, upper respiratory tract infection, headache, flu-like symptoms and skin reactions at the injection site.³ However, not everyone experiences these side effects, but if you ever do, it’s always important to seek medical attention right away. 

Biologics might not be the best option for you if you already have/are:

• Active infections such as tuberculosis, HIV, hepatitis^3,15
• Demyelinating diseases such as multiple sclerosis^3,15
• Congestive heart failure³
• Cancer^3,15
• Pregnant or breastfeeding. It has limited human data, if used, should be with caution.³
• Recently received a live vaccine MMR (measles, rubella, mumps), shingles¹⁵
• Undergoing moderate- and high-risk surgical procedures¹⁵
• History of allergic reactions to biologics¹⁵

It is important to discuss this with your doctor as these conditions should be assessed based on a case-by-case approach.

Those who are on biologics should be vaccinated against pneumonia and have an annual flu vaccination, or other vaccinations as recommended by physicians.⁹ However, they should avoid live vaccinations.⁹ It is always important to refer to your physician or pharmacist before having any vaccinations or taking any medications or supplements while on biologics.⁹

Your physician may conduct regular blood tests every 3 to 6 months.^6,7,8,9 If you have any concerns about it, feel free to discuss them with your doctor.

For more information regarding the different types of biologics, click on the link below

• Psoriasis Association https://www.psoriasis-association.org.uk/biologics

Have you read our previous article: Treatment of Psoriasis? Click here to know more https://www.doc2us.com/topic-3-treatment-of-psoriasis

CP-321422 July 2022

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REFERENCES

1. Gillespie, C. (2021). The Winding Road to Psoriasis Treatment - SELF. Available at https://www.self.com/story/road-to-psoriasis-treatment Website accessed: 3rd of March 2022
2. American Academy of Dermatology Association (AAD). (2022). Psoriasis Treatment:Biologics. Available at https://www.aad.org/public/diseases/psoriasis/treatment/medications/biologics#:~:text=Benefits%20of%20biologics,and%20swelling%20in%20your%20joints Website accessed: 3rd of March 2022
3. MOH Clinical Practice Guidelines. Management of Psoriasis Vulgaris (June 2013). Available at https://www.moh.gov.my/moh/attachments/9004.pdf. Website accessed: 3rd of March 2022
4. Nazario, B. (2021). Biologic and Biosimilar Medications for Psoriasis - WebMD. Available at https://www.webmd.com/skin-problems-and-treatments/psoriasis/biologic-medications-psoriasis Website accessed: 3rd of March 2022
5. CDC. Psoriasis. Available at https://www.cdc.gov/psoriasis/index.htm Website accessed: 3rd of March 2022
6. Psoriasis Association. Adalimumab. Available at https://www.psoriasis-association.org.uk/adalimumab Website accessed: 3rd of March 2022
7. Psoriasis Association. Stelara (Ustekinumab). Available at https://www.psoriasis-association.org.uk/stelara Website accessed: 3rd of March 2022
8. Psoriasis Association. Kyntheum (Brodalumab). Available at https://www.psoriasis-association.org.uk/kyntheum Website accessed: 3rd of March 2022
9. Psoriasis Association. Tremfya (Guselkumab). Available at https://www.psoriasis-association.org.uk/tremfya Website accessed: 3rd of March 2022
10. Psoriasis Association. Biologic Treatments. Available at https://www.psoriasis-association.org.uk/biologics Website accessed: 3rd of March 2022
11. Trettin, B, Feldman, S.R, Andersen, F, Danbjørg, D.B, & Agerskov, H. (2020). A changed life: The life experiences of patients with psoriasis receiving biological treatment. British Journal of Dermatology (1951), 183(3), 516-523. https://doi.org/10.1111/bjd.18876 Website accessed: 20th of April 2022
12. Maruthappu, T, & Bewley, A. (2021). A changed life: The life experiences of patients with psoriasis receiving biological treatment. British Journal of Dermatology (1951), 184(3), 580. DOI: 10.1111/bjd.19623 Website accessed: 20th of April 2022
13. Cafasso, J. (2021). Treating Psoriasis: 5 Reasons to Consider Switching to a Biologic - Healthline. Available at https://www.healthline.com/health/psoriasis/moderate-to-severe/5-reasons-to-switch-to-biologic-for-psoriasis#convenience Website accessed: 20th of April 2022
14. Gavidia, M. (2021). Biologic Use May Decrease Risk of Psoriatic Arthritis in Patients With Psoriasis - AJMC. Available at https://www.ajmc.com/view/biologic-use-may-decrease-risk-of-psoriatic-arthritis-in-patients-with-psoriasis Website accessed: 22nd of May 2022
15. Menter, Alan, Strober, Bruce E, Kaplan, Daniel H, Kivelevitch, Dario, Prater, Elizabeth Farley, Stoff, Benjamin, . . . Elmets, Craig A. (2019). Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. Journal of the American Academy of Dermatology, 80(4), 1029-1072. https://doi.org/10.1016/j.jaad.2018.11.057 Website accessed: 3rd of March 2022

Written by

Woong Yi Xin