Not everyone qualifies for this new treatment option.
Biologic therapy can be a life-changing option for people with severe psoriasis symptoms that have not responded to other treatment options. Biologics can yield results in just a month (or up to 12 weeks).
Psoriasis is an autoimmune condition that causes the immune system to attack the body’s skin cells, and biologics work by targeting the specific part of the immune system that is overreacting. (Learn more about how biologics treat psoriasis here.)
Like with many other health conditions, treatment for psoriasis can range from mild to more aggressive. Doctors always aim to find the mildest treatment option that yields effective results, in order to prevent unnecessary side effects.
People with mild psoriasis can often treat their skin symptoms with lifestyle changes to reduce inflammation, healthy skin care habits, and topical steroids. If these treatments are not enough, however, biologics may be considered.
“Biologics are currently approved for patients suffering from moderate to severe psoriasis,” says Bobby Buka, MD, dermatologist and section chief at Mount Sinai School of Medicine.
There are a number of factors that can determine whether someone has mild, moderate, or severe psoriasis, so the ideal candidates for biologics don’t always express the exact same symptoms.
If someone is experiencing a high emotional toll from psoriasis, their diagnosis may be considered moderate to severe even if their symptoms are not affecting a large portion of their body. This person may be a good candidate for biologic therapy.
For example: “You can have 10 percent of the body surface area involved with not much psycho-social impact, or you can have really severe dandruff that’s only five percent of the body’s surface area, but has a really depressive, emotional effect on a patient,” says Dr. Buka. The former may have more surface area involved, but the latter is experiencing greater quality-of-life impact.
Local vs. Systemic Treatment
Sometimes, psoriasis is localized to a single part of the body; other times, plaques may appear in numerous locations around the body.
If you only have one affected part of the body, it’s easy enough to treat it with a cream or ointment. “For patients [who] have psoriasis that involve multiple body parts, a cream or ointment may not make sense. That I think is an ideal candidate for biologic therapy,” says Dr. Buka.
Other Health Risks
Biologics only shut down a specific part of the immune system, which for the most part allows the body to continue to defend against most viral and bacterial infections.
Biologics are not recommended for patients who already have a compromised immune system, according to the National Psoriasis Foundation. Blood tests are required before starting a biologic.
Tuberculosis testing is also necessary. The same part of the immune system that creates psoriasis symptoms also helps protect against tuberculosis, according to Dr. Buka. “We want to make absolutely sure that before we start a biologic, these patients have not been exposed to tuberculosis,” he says.
Curious about how treatment with biologics works? Check out the treatment process for biologic therapy here.
Dr. Buka is a section chief at Mount Sinai School of Medicine. Dr. Buka is also a diplomate of the American Board of Dermatology and the Society for Pediatric Dermatology.
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I'm Dr. Bobby Buka.
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I'm a dermatologist at the Mt Sinai School
of Medicine, Department of Dermatology.
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Biologics are currently approved for
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patients suffering from moderate to severe
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Moderate to severe psoriasis can mean a
lot of different things for
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You can have 10 percent of the body
surface area involved with not
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much psycho-social impact.
00:00:20.420 --> 00:00:24.430
Or you can have really severe dandruff
that's only 5% of the body's surface area,
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but has a really depressive emotional
effect on a patient,
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I would certainly consider that moderate
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For localized psoriasis a cream or an
ointment may be enough.
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For, for patients that have psoriasis that
involve multiple body parts, a cream or
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ointment may not make sense.
00:00:38.860 --> 00:00:41.750
That I think is an ideal candidate for a
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What patients need to know before they
start a biologic.
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We need to do some baseline liver testing.
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We need to do baseline complete blood
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And we need to make sure,
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most importantly, that a patient doesn't
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Biologics work by shutting down a very
specific part of
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the immune system that's responsible for
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And is also responsible for protecting us
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So we wanna make absolutely sure that
before we start a biologic,
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these patients have not been expose to
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Biologics, I think, are really easy for
patients to use.
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There are two primary types that we use.
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One, the patient will inject themselves at
home usually every other week.
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And then the other one where they come
into the office and
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we inject them every three months.
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These at-home therapies, although a needle
may seem like a lot for
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a patient to handle, they're auto
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So you just put it against your leg and
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press a button, and the rest is done for
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In biologic therapy, the most common side
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see are a little bit of tendernesses at
the injection site.
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And I'd say most of my patients on
biologics get maybe one more upper
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respiratory illness over a year than my
patients not on biologic therapy.
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Compared to some of the conventional
agents that we used to use for
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psoriasis that had potential side effects
of liver failure or
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kidney failure, biologics don't have those
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It doesn't make them 100% safe, though.
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There's a very, very,
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very low incidents of some very severe
side effects, namely lymphoma or leukemia.
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We're seeing the very tip of the iceberg
for biologics in use for psoriasis and
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also other dermatologic conditions.
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So there are a number that are in the
pipeline that soon will come out
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in the next year or so.
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And they're really drilling down on
specific arms of the immune system that we
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don't need for anything else, but seem to
be driving psoriasis.
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I hope we'll see a cure for psoriasis in
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I don't think we will.
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I think it's a genetically driven
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Until we can maximize gene therapy,
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I don't think we'll be able to come up
with a cure for psoriasis.
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But we'll be able to lengthen the shot
interval for biologics.
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So if you're getting a shot once a year.
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Have we cured your psoriasis?
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No, but almost.
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Moderate to severe psoriasis and psoriatic arthritis: biologic drugs. Portland, OR: National Psoriasis Foundation. (Accessed on May 2, 2021 at https://www.psoriasis.org/about-psoriasis/treatments/biologics.)
Psoriasis resource center. Schaumburg, IL: American Academy of Dermatology. (Accessed on May 2, 2021 at https://www.aad.org/public/diseases/scaly-skin/psoriasis.)Psoriasis treatment: biologics. Schaumburg, IL: American Academy of Dermatology. (Accessed on May 2, 2021 at https://www.aad.org/public/diseases/scaly-skin/psoriasis/diagnosis-and-treatment-of-psoriasis/biologics.)