Plaque psoriasis is a skin condition that is characterized by inflammation, flaking, itching, and patches of skin which can be white, silver or red in color. These appear like thick patches of raised skin, thus the condition’s name plaque psoriasis. Plaque psoriasis is a genetic condition and an autoimmune condition, where your own immune system turns on the body itself. There is no cure for psoriasis, but there are many treatments that help you manage the disease. These treatments include light therapy, steroid creams, occlusion, and oral medications including biologics.
While there is no cure for plaque psoriasis, there are several ways that you can reduce the severity of your symptoms. There are many options for managing psoriasis, and you can even combine one or two options together to get relief. Your doctor will formulate the best treatment plan for you keeping the following in mind:
- The severity of your psoriasis
- What treatment options you have already tried
- If you have any other underlying medical condition
- How much effort you are willing to put in
- And whether or not your insurance will cover these treatment options financially
After considering all these factors, your doctor is probably going to recommend that you begin with a topical preparation for applying to your skin. These topical medications are generally the first step in any psoriasis treatment plan. Topical treatments work on treating your symptoms on the actual site of the psoriasis outbreak itself. The next step is systemic medications. Systemic medications work from inside the body by attacking the actual physiological processes that is causing the disease.
Systemic treatments are ideal for people who are having mild to severe plaque psoriasis. Systemic treatments are segmented into two categories – biologics and oral treatments. Biologics are also known as injectables as these drugs are only given through either intravenous infusion or through an injection. Oral medications are the ones that are available in liquid, pill, and rarely in injectable forms as well.
Difference between Injectable vs. Oral Plaque Psoriasis Meds
Injectable: Injectable or a biologic is a drug that is produced inside a living system, for example, a cell. Biologics are usually very large and complex molecules. They can also be a mixture of several molecules. Many injectables are also made with the use of recombinant DNA technology. They are generally taken either through intravenous infusion or through injections. It can be difficult, and sometimes even impossible, to characterize some of the complex biologics.
Oral Medication: Oral medications are those which are taken orally, and rarely some of them are taken through injection as well. These are typically produced through chemical synthesis, meaning that it is made by a combination of certain chemical ingredients and put together in an ordered procedure. These oral medications have a well-defined chemical structure.
Injectable vs. Oral Medications: Differences Based on How They Work
Injectables and how they Work
Injectable, or biologics as they are commonly known, are unique as they are actually manufactured from biological components or cells. The different between biologics and the more traditional drugs is that unlike biologics, traditional medications are manufactured from a mixture of chemicals in a laboratory and are not as complex as biologics. Biologics work by preventing inflammation that triggers a flare-up of psoriasis. Biologics stop the production of certain proteins in the body which causes inflammation. As biologics have an effect directly on the immune system, there are many risks and serious side effects associated with them. Side effects vary depending on the type of biologic you are on, though the most common risk is that of infection.
Even though biologics are relatively new to the market, over a short period of time itself, many biologics have become available on the market for treating psoriasis and even psoriatic arthritis. These include injectables like:
- adalimumab (brand name Humira)
- brodalumab (brand name Siliq)
- etanercept (brand name Enbrel)
- guselkumab (brand name Tremfya)
- ixekizumab (brand name Taltz)
- secukinumab (brand name Cosentyx)
- ustekinumab (brand name Stelara)
The biologic infliximab (brand name Remicade) is administered through an intravenous infusion by a doctor. The other biologics can be injected by the patients themselves at home itself.
Oral Medication and how they Work
Oral medications have been used for the treatment of plaque psoriasis for a much longer time as compared to biologics. Some of the common oral medications that are used for treating plaque psoriasis include:
- acitretin (brand name Soriatane)
- apremilast (brand name Otezla)
The above-mentioned drugs are taken orally in either a liquid or pill form.
Another popular oral medication is methotrexate that is either taken orally or through an injection.
Oral medications, in particular, apremilast, act upon the molecules that are present in the cells of your immune system. Oral medications also work by stopping certain enzymes that cause inflammation at the primary cell level itself.
The issue with oral medication is that they have some serious risks and side effects and you should not take them without consulting your doctor.
Injectable vs. Oral Medications: Comparison of Side Effects
Side Effects of Injectables
Adverse reactions from biologics vary depending on the specific injectable that is being used along with the method that is used for introducing the drug into the body.
Most injectables have a high potential to cause allergic reactions in the body. Biologic drugs that are used for treating plaque psoriasis work by suppressing the immune system. This is why they increase the risk of infections manifold in the person undergoing the treatment.
Some of the common side effects of injectables include the following:
- Reactions at the site of injection, including infections
- Drugs that are given intravenously have the potential to cause infusion reactions
- Fatigue or/and weakness
- High blood glucose levels
- Shortness of breath
- A headache
- Peripheral edema
- Reduced appetite
- Back pain or abdominal pain
- Low blood pressure
- Serum sickness
Side Effects of Oral Medications
Oral medications that are used for treating plaque psoriasis also have serious side effects. Many oral medications, similar to injectables, increase the risk of infection and kidney problems. If you are using these oral medications over a longer period of time then these side effects are also going to increase. For example, cyclosporine cannot be taken for a prolonged duration as it is known to cause kidney problems. Even the long-term use of methotrexate increased the risk of liver damage.
Some of the common side effects of oral medications for treating plaque psoriasis include:
- A headache
- Nausea and/or vomiting
- Infection of the upper respiratory tract
- Stuffy or a runny nose
- Heartburn or indigestion
- Weakness and fatigue
- Back pain or abdominal pain
- Increased frequency of bowel movements
- A sinus headache
- Tooth abscess
- Weight loss
Injectable vs. Oral Medications: Comparison of Dosage
Oral medications need to be taken once or twice a day. The exception to this rule is methotrexate as this drug is taken in three doses over a 24-hour period. Or it can also be taken as one weekly dose. Some biologics need to be taken in a clinical setting, particularly the ones that need to be administered through intravenous infusion. Oral medications have no requirement to be taken in a clinical setting. If the patient is able to administer the injection themselves, then they can take the medication at home by themselves also.
One exception to these medications is the newer oral drug of apremilast. This drug functions differently from other traditional medications for plaque psoriasis. According to research from the National Psoriasis Foundation, apremilast works on the cells or molecules of the immune system cells. The medication prevents a specific enzyme from being produced, thus stopping the cause of inflammation at the cellular level itself.
Deciding upon a particular psoriasis treatment is not that simple. Your doctor will take into consideration several factors before deciding which mode of treatment to put you on. Apart from deciding the right treatment, you and your doctor also need to keep in mind the adverse reactions caused by each type of treatment. On a general level, treatment with injectables is seen to be more convenient for psoriasis patients. However, biologics also carry the risk of serious side effects.
This is not to say that oral medications have lesser side effects, but these are probably the better option for patients who prefer to swallow a pill as compared to receiving an injection.
Therefore, discuss all pros and cons with your doctor and then only make an informed decision to select the ideal treatment option.