|Different Biologics for Psoriatic Arthritis|
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The different types of biologics available for treating PsA include tumor necrosis factor-alpha (TNF-alpha) inhibitors, interleukin 12 and 23 (IL-12, IL-23) inhibitors, interleukin 17 (IL-17) inhibitors, T-cell inhibitors, and interleukin 23 (IL-23) inhibitors. These include:
- TNF inhibitors, like Cimzia (certolizumab pegol) and Enbrel (etanercept), work by blocking TNF-alpha, a protein that signals the body to create inflammation. In people with PsA, there is excess TNF-alpha in their joints and skin. That ongoing inflammation can lead to rapid skin cell growth and joint tissue damage.
- IL-12/23, IL-17, and IL-23 inhibitors work by targeting IL-12/23, IL-17, and IL-23 cytokines that are connected to psoriatic inflammation. By targeting these proteins, people with PsA experience less pain, fewer symptoms, and a halt in disease progression.
- T-cell inhibitors, like Orencia, target T-cells, white blood cells involved in the inflammatory process that causes PsA. T-cell inhibitors block the ability of T-cells to produce inflammation.
Your doctor is in the best position to tell you whether you might benefit from biologic treatment. In general, these drugs are prescribed to people with moderate to severe PsA. They are also prescribed when other treatments have not worked, or when you cannot take other treatments because of side effects or for some other reason.
What To Expect
Biologics are administered either through injection or using an IV infusion (intravenously using a needle directly into the arm). Most biologic injections are done at home by yourself or with the help of a loved one. Infusion therapy is done at your doctor’s office, a hospital, or an infusion center.
Many of the biologic drugs approved for treating psoriatic arthritis are injected subcutaneously (under the skin). Subcutaneous injections are given in areas where you can pinch the skin, i.e., the abdomen or thighs.
Injections you can give yourself at home either come as a single-use syringe or a pen-like auto-injector. There are also powdered formulas in single-use vials. But because these require exact amounts of sterile water, they are often only used in medical settings.
Each biologic comes with preparation and dosing instructions. Your doctor can give you this information and walk you through the steps for injecting yourself. The drug packaging also provides step-by-step instructions.
Dosage for a biologic injection will be different based on the drug your doctor has prescribed. Some are given once or twice a week, some are once every other week, and others are once a month. You should ask your doctor about the different doses.
Biologic infusions used to treat PsA include Remicade and Simponi. These medications are given through an IV drip into a vein. An infusion appointment can take two or more hours to complete. Typically, infusion treatments are done every few weeks. Appointments can be done in a hospital, an infusion center, or your doctor’s office.
When you arrive to get your infusion, the clinician will place an IV into your vein, connected to a thin tube. Once the IV is placed, the clinician will start the infusion, and the medicine will move through the thin tube into your vein.
Make sure you feel well when you show up for an infusion appointment. This is to protect yourself and others who might also be immunocompromised (having a weak immune system). Most biologic treatments weaken your immune system. If you have an infection that is starting, having an infusion can make it worse.
After your first infusion, you will be monitored for up to an hour for any signs of an allergic reaction—swollen lips, shortness of breath, rash, etc. You will be provided with information about which side effects to watch out for and who to call after leaving the infusion site.
Headaches are common after biologic infusions and are often caused by fluid changes in the body. Fortunately, these headaches are temporary and should resolve within a day.
The effects of a PsA biologic begin a few weeks after the initial treatment. After you have had a few infusions, you will start to see the full effects, which can last for several months. Talk to your doctor about how you can best manage symptoms until your infusion treatments take effect.
Biologics Doctor Discussion Guide
Get our printable guide for your next doctor’s appointment to help you ask the right questions.
Risks and Side Effects
All treatments come with risks and benefits, and these should be weighed carefully before starting a new treatment. Your doctor is in the best position to explain all the pros and cons of biologic therapy for PsA and which drug might be best for your unique situation.
Biologics increase the risk for infection. To reduce this risk, you will be tested for tuberculosis (TB) and hepatitis before starting treatment. Your doctor will want to make sure you are up to date on vaccinations. These steps are mandatory before starting biologic drug therapy.
The most common side effects of the biologics used to treat PsA include respiratory infection, injection site reactions, and flu-like symptoms. These side effects are considered mild, and more serious side effects are rare. More serious side effects include some types of cancer, blood disorders, lupus-like symptoms, and cardiac reactions.
Doctors usually recommend more traditional DMARDs like methotrexate before they start you on a biologic. Additionally, some insurance companies will not cover biologic treatments until you have tried traditional therapies first.
In determining whether you are a candidate for biologics, your doctor will do a full assessment of your health, including your medical history, a physical exam, bloodwork, and other tests.
You should let your doctor know about other medications you are taking and take any vitamins and supplements. Some medications and supplements may interact with biologics.
You should hold off on starting a biologic when you are sick, even if it is as simple as the common cold. This is because biologic therapy impairs the immune system and increases infection risk.
Your doctor will screen for TB and/or hepatitis B before you start biologic therapy for PsA. Both are infections that biologics can reactivate.
You should get any necessary vaccines before you start biologic treatment. People who take biologics shouldn’t take live vaccines because they can pose serious health risks. Live vaccines include those for varicella and MMR (measles, mumps, and rubella).
Once you start biologic therapy, you should check with your doctor before getting any routine vaccines.
You should discuss with your doctor your risk for certain types of cancer. Some research has linked biologic drugs with an increased risk for skin cancers and lymphoma. This risk shouldn’t stop you from starting biologics, but you and your doctor will monitor it while treating PsA with a biologic.
Your experience on biologic drug therapy for PsA will be different than someone else’s. There will be several things to consider as you start biologic therapy and as you continue the course.
Improvement Takes Time
It may take three or more months of biologic treatment to feel less pain and have symptom improvement from PsA. However, studies have found biologics can offer mood improvements in a shorter time.
According to the National Psoriasis Foundation, this is important because people with PsA have a higher risk for depression and a depressed mood can worsen pain perception. That means the sooner you feel better mentally and emotionally, the sooner you will feel better physically.
Biologics are expensive and can cost anywhere from $10,000 to $30,000 a year. Your doctor will work with your insurance company to find a covered biologic to treat your PsA successfully. There are also patient assistance programs created by drug manufacturers that further reduce your costs and improve your access to biologic drug therapies for PsA.
Even on biologics, you might still experience flare-ups—periods where symptoms are worse than usual. Flare-ups are unpredictable—you might feel fine one day and the next, you are struggling to get out of bed.
If you are experiencing frequent flare-ups or short breaks between flares, you might want to talk to your doctor about whether your biologic is helping or whether it is time to start a different biologic for treating PsA.
Your biologic may not always be the reason you are experiencing flare-ups. PsA is associated with triggers—disease and lifestyle patterns that trigger symptoms. This might include things like cold weather, stress, diet, smoking, and overconsumption of alcohol.
Doing what you can to avoid triggers can pay off in the form of less pain, fewer symptoms, and improved quality of life.
Prioritizing Mental Health
Prioritizing your mental health can also help. Research shows people with PsA have a higher risk for depression and anxiety. And people who struggle to cope are more likely to experience PsA flare-ups.
Do what you can to invest in your mental health and better learn to cope with the many aspects of living with PsA, including joint and skin pain and fatigue. You should also make sure you are making healthy lifestyle choices, including eating healthy, staying active, not smoking, and not overindulging in alcohol.
Sticking To Your Treatment Plan
Treating PsA takes a lot of work, and it can be hard to keep up with all the aspects of your care. According to the Psoriasis Foundation, the main reason why PsA treatments fail is because of poor compliance.
Biologic therapy comes with some challenges, including high costs, fear of side effects, not feeling better quickly enough, or the timing of treatment might be inconvenient. It is also not uncommon for people to feel wary of biologics.
But your doctor has prescribed biologic drug therapy because they have determined the benefits outweigh the risks. And, fortunately, most of the newer biologics are effective and safe to use.
Stopping treatment, regardless of the reason, is never a good idea. You will likely find yourself with increased PsA symptoms and flares as soon as you stop using your biologic or other treatments. The decision to stop or reduce treatment should be made between you and your doctor.
Biologic drugs for psoriatic arthritis target various components of the inflammation response. The goal is to stop inflammation, relieve symptoms, and prevent further damage. They are usually considered after first trying other treatments.
Biologics are given by infusion or injection. Side effects include impaired defense against infections.
A Word From Verywell
Most people who try biologic drugs to treat psoriatic arthritis will see improvement in their symptoms. But they need to follow their doctor’s instructions for these treatments carefully.
It is also important to go to all regular follow-up medical visits to make sure your biologic is still working. When you see your medical provider, be sure to tell them about any problems or side effects you are experiencing.