What Are Biologics?
Reviewed by: HU Medical Review Board | Last reviewed: June 2022. | Last updated: July 2022
Psoriasis is an autoimmune condition in which symptoms called plaques develop on the skin due to inflammation in the body. This inflammation causes the body to produce an excess number of skin cells, which build up on the surface of the skin as plaques.
Psoriasis is a chronic, life-long condition, but there are many medications available to help manage its symptoms. Therapeutic biologic drugs, or “biologics” are types of therapies that include bioengineered proteins that mimic functions or block functions found in specific human genes or cells1. They have been used for more than a decade for treating people with moderate-to-severe psoriasis that does not respond well enough to topical treatments or other types of systemic medicines2.
Biologics are maintenance medications, meaning that they need to be taken over a longer time to have a full effect. They work by interfering with specific substances in the immune system to reduce or better regulate the inflammatory responses that cause psoriasis symptoms. They can be used alone or in combination with some medications.
People who are taking a biologic medication should carry a biological therapy alert card with them at all times. If you have to be treated in an emergency situation, this will enable healthcare providers to know you are taking a biological medication that may put you at increased risk of infection. They will also need this information to determine other drugs you can and cannot be given.
Biologic medications for psoriasis include:
What is Cimzia (certolizumab pegol)?
Cimzia is a biologic medication which targets and blocks tumor necrosis factor (TNF), a protein involved in the inflammatory response. In autoimmune diseases like psoriasis, the immune system is abnormally triggered and causes an increase in inflammation, which causes the inflamed patches on the skin. By blocking TNF, Cimzia can reduce the symptoms of psoriasis. Cimzia is a PEGylated TNF inhibitor. PEG is polyethylene glycol, a substance that is attached to a protein to make it stay in the body longer.15
The most common documented side effects of Cimzia include redness or pain at the injection site, upper respiratory infections, rash, and urinary tract infections. Cimzia may cause serious side effects, such as new or worsening of infections, which may require hospitalization.15
What is Cosentyx (secukinumab)?
Cosentyx is a biologic drug with the active ingredient secukinumab. It is a drug prescribed to those with moderate to severe plaque psoriasis. Cosentyx is a type of medication called an interleukin 17-A (IL-17A) blocker and works by blocking the function of the IL-17A proteins, which contribute to the excess inflammation that causes psoriatic symptoms. Cosentyx is taken long-term through injections1.
Common side effects include cold-like symptoms, diarrhea, and upper respiratory infection. Severe side effects that constitute medical attention include lightheadedness, swelling of the face, mouth or throat, difficulty breathing, tightness in the chest, and rash3. These may be signs of an allergic reaction. Additionally, some people with inflammatory bowel disease experienced worsening symptoms on Cosentyx. Some patients with active infections or certain medical conditions may not able to take Cosentyx.
Read more information about Cosentyx.
What is Enbrel (etanercept)?
Enbrel, which contains the active ingredient etanercept, is approved for treating moderate to severe plaque psoriasis. When taking this medication, an injection is given under the skin and may be used in combination with some systemic drugs, phototherapy, and topical treatments2. It helps alleviate symptoms by blocking an inflammation-causing protein released by cells that are overabundant in patients with psoriasis. This, in turn, lowers inflammation in the body.
People with certain other medical conditions cannot take Enbrel4. Common side effects include irritation upon injection site, headache, and upper respiratory injection. More serious side effects that are monitored for throughout treatment include nervous system problems, blood problems, heart failure, allergic reaction, worsening psoriasis, and autoimmune reactions.
Read more information about Enbrel.
What is Humira (adalimumab)?
Humira is an injectable biologic medication for treating moderate to severe plaque psoriasis. Humira contains the active ingredient adalimumab, which works by targeting and blocking a certain protein involved in the inflammatory response of the immune system. This reduces overall inflammation and psoriasis symptoms5.
Some common side effects for Humira include upper respiratory infections, headache, rash, and irritation around injection site6. Serious side effects linked to Humira include allergic reaction, nervous system problems, blood problems, heart failure, or worsening psoriasis. Individuals with certain medical conditions and/or individuals who are taking certain medications may not be able to take Humira.
Read more information about Humira.
What is ILUMYA (tildrakizumab-asmn)?
ILUMYA is used to treat plaque psoriasis in adults with moderate to severe plaque psoriasis who will benefit from systemic therapy (injection or pills), or phototherapy (UV light). ILUMYA works by inhibiting the release of pro-inflammatory proteins.
ILUMYA is considered safe to use in adults. The most common side effects of ILUMYA are upper respiratory infections, tiredness and diarrhea. Other side effects include angioedema, a swelling of the lower layer of skin and tissue just under the skin or mucous membranes, and urticaria, hives. As with most therapeutic agents, the risks and benefits of using ILUMYA should be considered in people with chronic or recurrent infections.
Read more information about ILUMYA.
What is Remicade (infliximab)?
Remicade, used to treat adults with chronic severe psoriasis, contains the active ingredient infliximab. Remicade is administered through intravenous (IV) infusion in a healthcare provider’s office. It works by targeting certain cytokine, a protein secreted by cells, that are involved in the body’s inflammatory response. The medication blocks the function of the cytokines and decreases the inflammation that causes psoriatic symptoms7.
Remicade is associated with common and more serious side effects8. The most common include respiratory infections, headache, fever, cough, and stomach pain. More serious side effects include heart failure, liver problems, blood issues, nervous system problems, allergic reactions, lupus-like symptoms, and worsened psoriasis symptoms. In addition, Remicade may increase the risk of developing certain types of cancer. People taking certain medications and/or who have specific medical conditions may not be able to take Remicade.
Read more information about Remicade.
What is SKYRIZI (risankizumab-rzaa)?
Skyrizi is an engineered biologic medication aimed at adults with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy. SKYRIZI is an interleukin-23 (IL-23) inhibitor, which means it blocks the action of IL-23, an important molecule for regulating the immune system.
SKYRIZI can lower the body’s ability to fight infections since it affects the immune response. The most common side effects among people in the clinical trial included upper respiratory infections, headache, and fatigue.
Read more information about Skyrizi.
What is Siliq (brodalumab)?
Siliq is a prescription biologic for moderate to severe plaque psoriasis in people who are candidates for systemic therapy or phototherapy, and whose disease has not responded to (or stopped responding to) other systemic therapies. Siliq targets interleukin-17 receptor A (IL-17RA), a key target in the inflammatory pathway.
The most common side effects included fungal infections, nausea, low white blood cell counts, diarrhea, fatigue, muscle pain, influenza, injection site irritation, headache, throat pain, and joint pain. Siliq has a black box warning – the strongest warning from the U.S. Food and Drug Administration (FDA) – because suicidal ideation and behavior, including completed suicides, were seen in patients taking Siliq in clinical trials.
Read more information about Siliq.
What is Stelara (ustekinumab)?
Stelara is a biologic medication used for patients with moderate to severe plaque psoriasis. Stelara contains ustekinumab, which is classified as an interleukin inhibitor and works by targeting specific proteins in the body to interfere with the inflammatory cycle that causes psoriasis symptoms1.
Stelara can increase the risk of infection, developing certain types of cancer and other conditions9. Side effects can include runny nose, upper respiratory infection, headache, tiredness, and irritation at the injection site. People with active infections, who could be pregnant, or live with other medical conditions should not able to use Stelara.
Read more information about Stelara.
What is Taltz (ixekizumab)?
Taltz is a biologic medication containing the active ingredient ixekizumab, which is approved for treating people with moderate to severe plaque psoriasis. This medication works by targeting certain proteins called cytokines and disrupting their role in the inflammation process to reduce psoriasis symptoms10. Taltz is administered by injection.
Taltz may increase the risk of developing an infection, and irritation at the injection site is a common side effect of the medication11. Taltz may not be recommended for people who are fighting an active infection, have tuberculosis, have inflammatory bowel disease, were recently vaccinated, or are pregnant.
Read more information about Taltz.
What is Tremfya (guselkumab)?
Tremfya is a systemic medication used to treat adults with moderate to severe plaque psoriasis. Tremfya is the first biologic therapy approved by the U.S. Food and Drug Administration (FDA) that selectively blocks interleukin (IL)-23, a cytokine (chemical messenger) that is involved in the inflammatory process of the immune system.12,13
Side effects of taking Tremfya can include upper respiratory infections, headache, pain or irritation at the site of the injection, joint pain, diarrhea, gastroenteritis (inflammation of the stomach and intestines that can cause diarrhea, vomiting, or pain), ear infections, and herpes simplex infections (like cold sores and genital herpes). Because Tremfya works by interrupting the inflammatory response of the immune system, it may increase the risk of infection. Patients should be tested for tuberculosis (TB) before starting treatment with Tremfya.14
Read more information about Tremfya.
Are biosimilars different than biologics?
Biosimilars are a type of biologic therapy that are highly similar to an already approved biological product. There are several biosimilars that may not be available yet but have been approved by the FDA for the treatment of psoriasis:
- Amjevita® (adalimumab-atto), a biosimilar to Humira® (adalimumab)
- Cyltezo™ (adalimumab-adbm), another biosimilar to Humira
- Erelzi® (etanercept-szzs), a biosimilar to Enbrel® (entanercept)
- Hyrimoz™ (adalimumab-adaz), another biosimilar to Humira
- Inflectra® (infliximab-dyyb), a biosimilar to Remicade® (infliximab)
- Renflexis™ (infliximab-abda), another biosimilar to Remicade
Read more about biosimilars for psoriasis.