Humira, Stelara, and More: 9 Biologics for Psoriasis and Psoriatic Arthritis

Psoriasis is a skin disorder that can cause rashes or thick, white scales on the skin. Psoriatic arthritis (PsA) is a type of arthritis that occurs in some people who have psoriasis. Both are autoimmune diseases caused by an overactive immune system. And they often require treatment with biologic medications.

Biologics are a class of medications used to treat conditions like psoriasis and PsA. They provide symptom relief and can also help keep the disease from getting worse. Biologics work by turning off the parts of the immune system that are overactive in psoriasis and PsA. They're given as subcutaneous (under the skin) injections or intravenous (into the vein, IV) infusions.

Here, we'll discuss nine different biologics approved to treat both moderate to severe plaque psoriasis and PsA.

1. Cimzia

Cimzia (certolizumab pegol) is a tumor necrosis factor-alpha (TNF) blocker. TNF-alpha causes inflammation in the skin and joints, so blocking it helps improve psoriasis and PsA symptoms. Cimzia comes as a subcutaneous injection given every 2 to 4 weeks, and it's only approved for adults. It comes in a prefilled syringe or as a vial of powder that must be mixed and drawn up in a syringe before injecting.

Cimzia can interfere with a blood test that measures how fast your blood clots, called activated partial thromboplastin time (aPTT). Cimzia can make your aPTT level look higher than it is. Make sure to tell your healthcare provider that you take Cimzia before having blood work done.

How to save: Cimzia is only available as a brand-name medication. If you have commercial insurance, you may be eligible to pay as little as $0 for Cimzia using a savings card from the manufacturer. The manufacturer will also cover the cost of your medication if your insurance coverage is delayed or denied. If you're uninsured or underinsured, you may be eligible for Cimzia's patient assistance program, which offers the medication free of cost.

2. Enbrel

Enbrel (etanercept) is another TNF-alpha blocker approved for treating psoriasis in adults and children 4 years and older and PsA in adults. It's given as a weekly subcutaneous injection. It can also be given twice weekly for more severe symptoms.

Enbrel comes in a prefilled syringe, a vial of liquid, or as a vial of powder that must be mixed before injecting. It also comes in an autoinjector device (pen). This pen allows you to control how fast you receive your dose and doesn't require you to use a syringe or vial of medication.

Enbrel can interact with certain medications that treat diabetes, causing low blood glucose levels (hypoglycemia). Make sure to give your healthcare provider your current medication list. This will allow them to check for any possible drug interactions with Enbrel.

How to save: Enbrel is only available as a brand-name medication, but there are ways to save on the cost. If you have commercial insurance, you may be eligible to pay as little as $0 per month for Enbrel using a savings card from the manufacturer. If you're uninsured or underinsured, you may be eligible for Enbrel's patient assistance program, which offers the medication free of cost.

3. Humira

Humira (adalimumab), another TNF-alpha blocker, treats psoriasis and PsA in adults. It's usually given as a subcutaneous injection every other week. But injections may be given weekly if needed. It typically comes in a prefilled syringe or an injection pen that's easier to use.

Humira's original formulation contains an ingredient called citrate. This ingredient can make injections more painful for some people.

Newer Humira products are citrate free and more concentrated. This means they deliver the same amount of medication in a smaller amount of liquid. These changes make injections faster, easier, and less painful.

How to save: There are ways to save on Humira, which is available as a brand-name medication. If you have commercial insurance, you may be eligible to pay as little as $5 per month for Humira using a savings card from the manufacturer. If you're uninsured or underinsured, you may be eligible for Humira's patient assistance program, which offers the medication free of cost. Humira also has several approved biosimilars that may help you save on the cost of your medication.

4. Remicade

Remicade (infliximab) is a TNF-alpha blocker that's available as an IV infusion for psoriasis and PsA in adults. So it's typically given in a healthcare setting. Remicade takes about 2 hours to infuse, and the total time for treatment will likely be longer. But you'll usually only receive infusions every 6 to 8 weeks (after an initial loading period, where infusions are given more frequently to get the medicine working faster). While many biologics have a fixed dose, Remicade is dosed based on your body weight.

Like with all biologics that affect your immune system, live vaccines aren't recommended while you're receiving Remicade. And if you receive Remicade while pregnant, your newborn shouldn't receive a live vaccine until they are at least 6 months old.

How to save: Remicade is available as both a branded and unbranded version (infliximab). If you have commercial insurance, you may be eligible to pay as little as $5 per infusion of either version using a savings card from the manufacturer. If you're uninsured or underinsured, you may be eligible for Remicade's patient assistance program, which offers both the branded and unbranded versions free of cost. There are also several other approved biosimilars for Remicade, which may help you save on the cost of your medication.

5. Stelara

Stelara (ustekinumab) is an interleukin-12 and -23 inhibitor. Interleukins (ILs) are proteins in the immune system, and they may be overactive in certain autoimmune conditions. Blocking certain interleukins (like IL-12, IL-17, and IL-23) helps treat psoriasis and PsA symptoms.

Stelara is FDA approved for treating psoriasis and PsA in adults and children 6 years and older. After the loading period, it's given every 12 weeks (3 months). It comes in a prefilled syringe or as a vial of liquid for subcutaneous injection. It's also available as an IV infusion.

How to save: There are ways to save on Stelara, which is only available as a brand-name medication. If you have commercial insurance, you may be eligible to pay as little as $5 per dose for Stelara using a savings card from the manufacturer. If you're uninsured or underinsured, you may be eligible for Stelara's patient assistance program, which offers the medication free of cost.

6. Skyrizi

Skyrizi (risankizumab-rzaa) is an IL-23 inhibitor. It's approved for psoriasis and PsA in adults and comes in a prefilled syringe or injection pen. You'll only need a dose every 12 weeks after the initial loading doses.

How to save: Skyrizi is available as a brand-name medication. If you have commercial insurance, you may be eligible to pay as little as $5 per dose using a savings card from the manufacturer. If you're uninsured or underinsured, you may be eligible for Skyrizi's patient assistance program, which offers the medication free of cost.

7. Cosentyx

Cosentyx (secukinumab) blocks IL-17A and is approved for treating psoriasis in adults and children 6 years and older and PsA in adults and children 2 years and older. It's given as a subcutaneous injection or an IV infusion every 4 weeks, and may be given with or without loading doses. Depending on your prescribed dose (150 mg or 300 mg), you may have to inject 1 or 2 doses at a time. It comes in a prefilled syringe or a single-dose injection pen.

Of note, Cosentyx isn't a good option for people with an inflammatory bowel disease (like Crohn's or ulcerative colitis) as it can cause disease flares.

How to save: If you have commercial insurance, you may be eligible to pay as little as $0 per month for Cosentyx using a savings card from the manufacturer. If you're uninsured or underinsured, you may be eligible for Cosentyx's patient assistance program, which offers the medication free of cost.

8. Taltz

Taltz (ixekizumab) also blocks IL-17A to treat psoriasis in adults and children ages 6 and over and PsA in adults. It's given as a monthly subcutaneous injection and comes in a prefilled syringe or single-dose pen. Taltz also recently changed its formula to take out the citrate - making injections less painful. The original formulation of Taltz is no longer available.

Taltz is also not a good option for people with inflammatory bowel disease.

How to save: Taltz is only available as a brand-name medication. If you have commercial insurance, you may be eligible to pay as little as $5 or $25 per dose using a savings card from the manufacturer. If you're uninsured or underinsured, you may be eligible for Taltz's patient assistance program, which offers the medication free of cost.

9. Tremfya

Tremfya (guselkumab) is the newest interleukin inhibitor approved for treating psoriasis and PsA in adults. It blocks IL-23, and is given as a subcutaneous injection every 8 weeks (2 months) after the loading period. It comes in a prefilled syringe or autoinjector.

Tremfya has an autoinjector that allows you to determine the speed of the injection. Because of this, Tremfya injections may be less painful than some other biologics for psoriasis and PsA.

How to save: Tremfya is only available as a brand-name medication. If you have commercial insurance, you may be eligible to pay as little as $5 per dose using a savings card from the manufacturer. If you're uninsured or underinsured, you may be eligible for Tremfya's patient assistance program, which offers the medication free of cost.

Are biologics safe?

Biologics are generally considered safe medications. The FDA wouldn't approve them otherwise. But like all medications, they do have risks and side effects to be aware of. These can vary depending on which medication you're receiving.

Biologics aren't the right option for everyone. For example, TNF-alpha blockers aren't recommended for people with heart failure, since they can make heart failure worse. Your healthcare provider will look at your medical history to decide if a biologic is the right choice for your psoriasis and PsA symptoms.

Side effects of biologic medication

As mentioned, the side effects of biologics vary based on which one you're receiving. But in general, there are some risks and side effects to be aware of, including:

• Injection-site reactions. Since these medications are injected or infused, it's common to have mild pain or irritation at the site of the injection.

• An increased risk of infections. These are usually mild infections, such as the common cold or a urinary tract infection. But in rare cases they can be severe infections, such as pneumonia or sepsis.

• An increased risk of cancer.Cancers, including lymphomas, have been reported in some people receiving biologics. But this side effect isn't common, and the risk depends on the person.

When are biologics typically used in treating psoriasis and psoriatic arthritis?

When determining your treatment options, your healthcare provider will consider several factors, like how severe your symptoms are, your medical history, and the other medications you take. This can help them determine if a biologic is right for you. Often, biologics are a first-choice option for moderate-to-severe symptoms because they work well to treat psoriasis and PsA symptoms.

But cost may be a factor, because biologics can have a higher price tag than other medications. There are biosimilars available for some biologic medications. Biosimilars are often more affordable versions of their reference (original) biologic. But your provider may want to try other, less expensive medications first.

Keep in mind that it can take time to find the biologic that works best for you. You may also need to change medications at some point if you're no longer getting relief. That's because your immune system can develop antibodies against the biologic you're taking which can make it less effective.