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Biologics for Psoriasis

Examples

Generic Name Brand Name
adalimumab Humira
alefacept Amevive
etanercept Enbrel
golimumab Simponi
infliximab Remicade
ustekinumab Stelara

These medicines are also called tumor necrosis factor antagonists (TNF antagonists).

These medicines may be given in an IV (intravenously) or as a shot.

How It Works

Biologics block harmful responses from the body's immune system that lead to the symptoms of psoriasis.

Why It Is Used

Biologics such as adalimumab, alefacept, etanercept, golimumab, infliximab, or ustekinumab are used to treat moderate to severe chronic plaque psoriasis and psoriatic arthritis. Some biologics may be used for treating both conditions.

How Well It Works

These biologics significantly reduce symptoms of psoriasis, providing rapid and sustained improvement. Continued treatment can lead to extended remission from symptoms.1

One study showed that etanercept was effective for treating psoriasis in children.2

Side Effects

The most common side effect of these biologics is an allergic reaction to the injection (shot) or infusion (medicine given in a vein, intravenously, or IV). If you have a reaction to the shot or infusion, it will happen right away, either during the infusion or within 1 to 2 hours after the infusion or shot. Your doctor may give you medicines to prevent or stop the reaction.

Symptoms of a shot or infusion site reaction include:

  • Fever and chills.
  • Chest pain and shortness of breath.
  • Itching and rash.
  • Headache.
  • Nausea.
  • Heat and redness (flushing) in the face.
  • Fatigue and dizziness.

Warnings have been issued about serious side effects of these biologics. The U.S. Food and Drug Administration (FDA) and the medicine’s manufacturers have warned about:

  • An increased risk of a serious infection. TNF antagonists affect your body's ability to fight all infections. So if you get a fever, cold, or the flu while you are taking this medicine, let your doctor know right away.
  • An increased risk of blood or nervous system disorders. Call your doctor if you have symptoms of blood disorders (such as bruising or bleeding) or symptoms of nervous system problems (such as numbness, weakness, tingling, or vision problems).
  • A possible increased risk of developing lymphoma (a type of blood cancer). It is not clear whether this increase is because of the drug or because people with this disease may already have a higher risk.3 There have been reports of a rare kind of lymphoma, occurring mostly in children and teens taking some of these biologics, that often results in death.
  • An increased risk of liver injuries. Call your doctor if your skin starts to look yellow, if you are very tired, or if you have dark brown urine and/or a fever.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

The safety of long-term treatment with biologics is not known.

These medicines probably will have to be taken for long periods of time—possibly even for life.

Because biologics interfere with the immune system, it's possible that they may raise your risk of infection, anemia, and possibly even cancer. Medicines that suppress the immune system are not usually given to people with impaired immune systems. If you take biologic drugs, you may have periodic tests for tuberculosis.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

  1. Abramowicz M (2008). Drugs for acne, rosacea and psoriasis. Treatment Guidelines From The Medical Letter, 6(75): 75–82.
  2. Paller AS, et al. (2008). Etanercept treatment for children and adolescents with plaque psoriasis. New England Journal of Medicine, 358(3): 241–251.
  3. Menter A, Griffiths CEM (2007). Current and future management of psoriasis. Lancet, 370(9583): 272–284.

Credits

By Healthwise Staff
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer Amy McMichael, MD - Dermatology
Last Revised January 9, 2012

Last Revised: January 9, 2012

Author: Healthwise Staff

Medical Review: Adam Husney, MD - Family Medicine & Amy McMichael, MD - Dermatology

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