Help for Severe Psoriasis

If you’re one of the 1.5 million Americans suffering from moderate or severe psoriasis, you may feel like you’ll never get relief from your itchy, painful, uncomfortable condition. Topical creams—usually the go-to treatment for milder psoriasis—often aren’t much help for more serious symptoms. But the truth is: You can get help.  Even though there isn’t a cure (yet) for this autoimmune inflammatory disease, powerful medications that target the root causes of psoriasis are available—with more on the way. Here’s what you need to know.

Breaking Down Biologics
What is a “biologic”? Simply put, it’s a protein-based drug made from living cells. They’ve actually been used for more than 100 years in various forms (vaccines and insulin are two), but the first biologics for treating psoriasis and psoriatic arthritis were approved only about a decade ago. In psoriasis, the immune system stokes inflammation in the skin that causes skin cells to grow abnormally.  Unlike some other psoriasis treatments that suppress the immune system as a whole, biologics directly target the specific cells or proteins involved in this process. Doctors typically recommend them after other treatments have failed.

Biologics are either given by injection (a shot) into the leg, arm or abdomen, or by infusion (an IV). Seven of these drugs are currently approved for psoriasis and/or psoriatic arthritis: Cimzia (certolizumab pegol), Cosentyx (secukinumab), Stelara (ustekinumab), Humira (adalimumab), Enbrel (etanercept), Simponi (golimumab) and Remicade (infliximab). More new options are showing promise in clinical trials. How often you receive the medication and how you get it depends on the biologic you choose. For example, you’d give yourself an injection of Enbrel once or twice a week, while your healthcare provider would administer Stelara every 12 weeks.

Each drug has various pros and cons. Your doctor can help you find the choice that is right for you. 

The Downside of Biologics

While biologics are the most effective treatment available for psoriasis, these drugs do have their drawbacks. For one thing, they can be expensive and some insurance companies may not cover the full cost of treatment. The other drawback is that like most medications, there are side effects. Biologics can increase your risk of infections—most often respiratory infections—that can become serious.

You may not be able to take certain biologics if your immune system is compromised, if you take other medications that affect your immune system, or if you have certain illnesses such as multiple sclerosis or hepatitis B. In rare cases biologics can cause serious nervous system disorders, blood disorders and some types of cancer. If you notice any side effects while taking biologics, contact your doctor right away. 

Open Wide
Biologics aren’t the only advances in treating psoriasis. A new category of medications known as “small-molecule” drugs, have recently entered the scene.  Like biologics, they target specific parts of the immune system, but an advantage is that many of the drugs are taken as a pill instead of a shot or IV. Some also don’t raise your risk of infection.

The newest FDA-approved oral treatment available for treating both psoriasis and psoriatic arthritis is Otezla (apremilast). This drug inhibits an enzyme that’s responsible for the inflammation reaction within your cells. Otezla is pill that you take twice a day. The most common side effects include nausea, headache and diarrhea. A small group of people also reported unexplained weight loss; so if you take Otezla make sure you monitor your weight regularly.

Tofacitinib (Xeljanz), an oral rheumatoid arthritis drug, is also being studied for potentially treating psoriasis. Many more similar drugs are in the pipeline.

Future Treatments
We don’t know what the next decade will have in store for psoriasis treatment. But, what we do know is that as more and more medications reach the end of their clinical trials phase, people with psoriasis will have an even larger menu of options to choose from than ever before to find relief.

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