Some of the most important treatment options for psoriasis come from biology: drugs made from human or animal proteins that are designed to inhibit immune system defects which are linked to the disease.
There are four so-called biologic agents that are Food and Drug Administration approved for treating either psoriasis or psoriatic arthritis: All of them are expensive. Biologic agents usually cost $1,000 a month or more, but the cost is generally covered by insurance (some companies may require special authorization in advance.) The four biologic drugs include:
Amevive (alefacept)—Alefacept is approved for use in moderate to severe chronic plaque psoriasis. It works by inhibiting the action of T cells, which are cells that promote inflammation. Because the medication must be injected into the muscle, treatment involves weekly visits to a doctor's office for 12 weeks. Some patients need a second course of treatment.
Possible side effects include a reduction in the number of white blood cells, an increased risk of cancer and the development of hives on the skin. Liver injury and allergic reactions are possible. Alefacept should not be used in combination with light treatments or with other agents that suppress the immune system.
Raptiva (efalizumab)—Like alefacept, efalizumab is approved for use in moderate to severe chronic plaque psoriasis and works by inhibiting the action of T cells. Because the medication is injected just under the skin, patients are able to give themselves their own injections. Treatment involves one injection a week for 12 weeks.
The most common side effects are flu-like symptoms such as headache, nausea, chills, fever and pain. Skin lesions, reddening of the skin, decrease in blood platelets, anemia, serious infections and an increased risk of cancer also are possible. People taking efalizumab should not receive any vaccines as the drug can prevent them from working.
Enbrel (etanercept)—Etanercept is approved to treat both psoriasis and psoriatic arthritis. It works by inhibiting the action of TNF alpha, an infection-fighting molecule that is overproduced in psoriasis. Patients give themselves injections once a week.
Health
Possible side effects include allergic reactions at the injection site, upper respiratory tract infections and sinusitis. There may also be an increased risk for serious infections and cancer. People with heart failure should be cautious about using etanercept, and people taking etanercept should not be vaccinated with live vaccines.
Remicade (infliximab)—Infliximab is approved for treating psoriatic arthritis. Like etanercept, it works by inhibiting the action of TNF alpha. The drug is administered intravenously in a doctor's office, starting every two weeks and progressing to every eight weeks.
Possible side effects include serious infections, cancer, a decrease in the number of white blood cells or platelets in the blood, aplastic anemia, heart failure, allergic reactions and neurologic disorders.
Questions to ask your doctor:
1. Would I benefit from a biologic agent?
2. Would I be able to give myself the injections?
3. Are there any medications I need to avoid if I'm using a biologic agent?
4. What vaccines should I avoid?
