Harnessing Biologics for Psoriasis Treatment : A Breakthrough Approach

Biologics are a class of medications that have revolutionized the treatment of psoriasis and several other autoimmune conditions. Unlike traditional pharmaceuticals, biologics are derived from living organisms or their components and are designed to target specific molecules in the immune system that contribute to inflammation and disease. Read on to delve into the world of harnessing biologics for psoriasis treatment and how this is emerging as a breakthrough approach.

As mentioned above, biologics are a class of drugs derived from living organisms or their components, such as proteins, genes, or cells. Unlike traditional chemical drugs, which are synthesized through chemical processes, biologics are produced using biological systems like bacteria, yeast, or mammalian cells.⁽¹⁾

These medications are designed to target specific molecules or pathways in the body’s immune system, thereby modulating the immune response and treating various medical conditions, particularly autoimmune diseases and certain types of cancer.⁽²⁾

Biologics have significantly advanced medical treatments, offering targeted therapies with often fewer side effects compared to traditional drugs. They are used in a wide range of conditions, including rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis, and psoriasis, among others, to manage and control disease symptoms.^(3,4)

Biologics have proven to be highly effective in the treatment of psoriasis, particularly in cases of moderate to severe psoriasis that have not responded well to other treatments. Psoriasis is an autoimmune disease characterized by an overactive immune system that leads to the rapid growth of skin cells, resulting in red, scaly plaques. Biologics are specifically designed to target and modify components of the immune system responsible for inflammation and the development of psoriatic symptoms.⁽⁵⁾

Biologics used for psoriasis, such as TNF-alpha inhibitors (e.g., etanercept, adalimumab), IL-17 inhibitors (e.g., secukinumab, ixekizumab), and IL-23 inhibitors (e.g., guselkumab, risankizumab), work by blocking specific cytokines or immune pathways involved in psoriasis. By doing so, they help reduce inflammation and the excessive skin cell growth that characterizes psoriasis.⁽⁶⁾

Biologics have been a game-changer for many people with psoriasis, offering a higher rate of symptom improvement and a better quality of life compared to traditional treatments. However, their use often involves ongoing monitoring and potential side effects, which should be discussed with a healthcare provider to determine the most suitable treatment approach based on your specific condition and needs.

Biologics have emerged as a diverse and effective arsenal for combating psoriasis, with different classes tailored to specific immune system targets. These classes include: 

1. TNF-alpha Blockers: This group, which includes adalimumab (Humira), etanercept (Enbrel), and certolizumab pegol (Cimzia), acts broadly by inhibiting tumor necrosis factor-alpha (TNF-alpha). These biologics are approved for both psoriasis and psoriatic arthritis and require dosing every week or every other week, offering a more generalized approach to immune system regulation.⁽⁷⁾

2. IL-12/23 Inhibitor: Ustekinumab (Stelara) is the sole representative in this class, targeting interleukin 12 and 23 (IL-12/23). It can effectively treat both psoriasis and psoriatic arthritis, with a dosing regimen of every 12 weeks.⁽⁸⁾

3. IL-17 Inhibitors: Secukinumab (Cosentyx), ixekizumab (Taltz), and brodalumab (Siliq) belong to this class, focusing on interleukin 17 (IL-17). These biologics are suitable for both psoriasis and psoriatic arthritis, necessitating dosing every 2–4 weeks. They offer a more specific approach to immune modulation.⁽⁹⁾

4. IL-23 Inhibitors: The newest addition to the biologic family, IL-23 inhibitors, comprises risankizumab-rzaa (Skyrizi), guselkumab (Tremfya), and tildrakizumab-asmn (Ilumya). These drugs are approved specifically for psoriasis treatment and are administered every 8–12 weeks. IL-23 inhibitors provide targeted immune modulation, offering the potential for fewer side effects.^(10,11)

The choice of biologic therapy depends on the individual’s condition, preferences, and response to treatment. Doctors consider factors like the severity of psoriasis, the presence of psoriatic arthritis, and your overall health when selecting the most suitable biologic.

Biologics work within the body to alleviate psoriasis symptoms by targeting specific components of the immune system involved in the inflammatory response. As mentioned earlier, psoriasis is an autoimmune condition where the immune system mistakenly attacks healthy skin cells, causing rapid skin cell turnover and the formation of psoriatic plaques. Biologics are designed to intervene in this immune response.

Here’s how biologics work to relieve psoriasis symptoms: 

1. Through Targeted Inhibition: Each class of biologics focuses on specific molecules or cytokines in the immune system. For example, TNF-alpha blockers target tumor necrosis factor-alpha, IL-17 inhibitors target interleukin 17, and IL-23 inhibitors target interleukin 23. By targeting these specific cytokines, biologics interrupt the immune system’s inflammatory signaling pathways, reducing the overactive immune response that drives psoriasis.⁽¹²⁾

2. Through Immune Modulation: Biologics help modulate the immune system, balancing it and preventing excessive inflammation. This modulation reduces the inflammation responsible for the characteristic redness, scaling, and plaques associated with psoriasis.⁽¹³⁾

3. Through Skin Cell Proliferation: Biologics can also slow down the rapid turnover of skin cells seen in psoriasis. By inhibiting the immune system’s attack on skin cells, they help normalize the skin’s growth and shedding process, reducing the development of psoriatic plaques.⁽¹⁴⁾

4. Through Long-Term Control: Unlike some other psoriasis treatments, which may provide temporary relief, biologics offer a more sustained approach. They can provide long-term control of psoriasis symptoms, allowing people to enjoy extended periods of clear skin and improved quality of life.

5. Reduced Side Effects: Biologics are often associated with fewer systemic side effects compared to traditional systemic medications. This is because they specifically target the immune system components involved in psoriasis without affecting the entire immune system.⁽¹⁵⁾

There is no doubt that biologics offer a highly effective and targeted approach to treating psoriasis, helping individuals achieve symptom relief, clearer skin, and an improved quality of life. However, their use should be carefully monitored by healthcare providers to ensure optimal outcomes and minimize potential side effects.

Yes, like any other medication, biologics used to treat psoriasis can also have side effects. However, it is important to note that the severity and specific side effects can vary depending on the type of biologic and the individual’s response. Common side effects of biologics for psoriasis may include:^(16,17) 

• Injection Site Reactions: Redness, swelling, itching, or pain at the injection site is a common side effect. These reactions are typically mild and temporary.

• Infections: Biologics can suppress the immune system to some extent, making individuals more susceptible to infections. This can include respiratory infections, skin infections, and, in rare cases, serious infections like tuberculosis.

• Allergic Reactions: Although uncommon, some individuals may experience allergic reactions to biologics, which can manifest as hives, rash, difficulty breathing, or swelling of the face, lips, or tongue. Allergic reactions require immediate medical attention.

• Changes in Liver Enzymes: In some cases, biologics may lead to elevated liver enzyme levels, which may require monitoring during treatment.

• Gastrointestinal Symptoms: Gastrointestinal symptoms such as nausea, diarrhea, or abdominal pain can occur, although they are typically mild and transient.

• Headaches: Headaches are a common side effect reported by individuals on biologic treatment.

• Flu-Like Symptoms: In some cases, individuals may develop flu-like symptoms, including fever, chills, and fatigue.

• Nausea: Nausea or stomach upset can occur as a side effect of certain biologics.

• Neurological Symptoms: Some biologics may be associated with neurological symptoms such as tingling, numbness, or vision changes.

• Increased Risk of Skin Cancer: Although the risk is low, some biologics may slightly increase the risk of skin cancer, particularly in those with a history of extensive sun exposure.^(18,19)

When a biologic treatment for psoriasis becomes ineffective or loses its effectiveness over time, taking appropriate steps is crucial to address the situation. While many people experience benefits from biologics for an extended period, there are instances where the response diminishes. Several factors can contribute to this, including the development of antibodies against the medication, genetic variations, and individual responses to different biologic classes.

If your response to a biologic wanes or is inadequate, there are certain things that you can do, including: 

• Consult With Your Dermatologist: Schedule a consultation with your dermatologist or healthcare provider who is overseeing your psoriasis treatment.

• Review Medication Adherence: Ensure that you have been adhering to the prescribed treatment regimen correctly, including dosing schedules and administration techniques.

• Explore Genetic Factors: Recognize that psoriasis is influenced by genetic mutations, and some people may respond differently to various biologics based on their genotype. While not all genetic mutations causing psoriasis are known, your healthcare provider can consider your genetic profile when selecting the most appropriate biologic.

• Consider a Different Biologic: If the current biologic is no longer effective, your dermatologist may recommend switching to another biologic within the same class or a different class. Different biologics target distinct aspects of the immune system, and a change in medication might yield better results.

• Evaluate Combination Therapy: In some cases, combining a biologic with another psoriasis medication or treatment approach may enhance its effectiveness. Your healthcare provider can assess whether combination therapy is suitable for your situation.

Biologics have revolutionized psoriasis treatment, offering targeted relief to many individuals. While highly effective, close collaboration with healthcare providers is crucial for monitoring progress and addressing any side effects. Ongoing research promises further advancements in psoriasis therapies, providing hope for better management of this challenging condition.  It is essential to work closely with your dermatologist to find the most effective psoriasis treatment for your specific situation.

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