Psoriasis

What injections or infusions are available for psoriasis?

The newest category of psoriasis drugs are called biologics. All biologics work by suppressing certain specific portions of the immune system that are overactive in psoriasis. Available biologic drugs include alefacept (Amevive), adalimumab (Humira), infliximab (Remicade), etanercept (Enbrel), and ustekinumab (Stelara). Newer drugs are in development and available in the near future. As this class of drugs is fairly new, ongoing monitoring and adverse effect reporting continues and long-term safety continues to be monitored.

A recently approved biologic product for adults who have a moderate to severe form of psoriasis is ustekinumab (Stelara). Stelara is a laboratory-produced antibody that treats psoriasis by blocking the action of two proteins (interleukins) that contribute to the overproduction of skin inflammation.

Some biologics are to be administered by self-injections for home use while others are given by intravenous infusions in the physician's office.

Biologics have some screening requirements such as a tuberculosis screening test (TB skin test or PPD test) and other labs prior to starting therapy.

As with any drug, side effects are possible with all biologic drugs. Common potential side effects include mild local injection-site reactions (redness and tenderness). There is concern of serious infections and potential malignancy with nearly all biologic drugs.

Precautions include patients with known or suspected hepatitis B infection, active tuberculosis, and possibly HIV/AIDS. As a general consideration, these drugs may not be an ideal choice for patients with a history of cancer and patients actively undergoing cancer therapy.

In particular, there may be an increased association of lymphoma in patients taking biologics. It is not at all certain if this association is directly caused by these drugs. In part, this is because it is known that certain diseases like rheumatoid arthritis or psoriasis may be associated with an inherent increase in the overall risk of some infections and malignancies.

Biologics are expensive medications ranging in price from several to tens of thousands of dollars per year per person. Their use may be limited by availability, cost, and insurance approval. Not all insurance drug plans may fully cover these drugs for all conditions. Patients need to check with their insurance and may require a prior authorization request for coverage approval. Some of the biologics manufacturers have patient-assistance programs to help with financial issues.

The choice of the right medication for your condition depends on many medical factors. Additionally, convenience of receiving the medication and lifestyle may be factors in choosing the right biologic medication.

Reviewed on 5/2/2014