Psoriasis treatments: biological systemic medicines

Megan and Hannah had both tried biological systemic treatments for their psoriasis. These medicines work by reducing the inflammation of psoriasis and are usually used when psoriasis is severe, hasn’t responded to other treatments or if other treatments can’t be used because of side effects. Biological systemic treatments are quite new medicines and are being closely followed by researchers to check there are no unexpected side effects from their use with psoriasis. Adam and Lucy had heard about these treatments, sometimes also shortened to ‘biologics’, but said they aren’t eligible. There are strict guidelines about prescribing biological systemic treatments and they can only be used in specific cases of psoriasis. Lisa asked her doctor about them but was told it was an “extreme last resort” and her psoriasis coverage/severity wasn’t high enough.

There are different medicines currently approved for treating psoriasis, including: 
  • adalimumab (e.g. Humira)
  • etanercept (e.g. Enbrel)
  • ustekinumab (e.g. Stelara)
  • secukinumab (e.g. Consentyx)
  • infliximab (given through a drip in hospital)
Blood tests are needed before starting biological systemic treatment. Treatments are then given as a regular injection – how often depends on which medicine and brand. Hannah chose to take Stelara (ustekinumab) as she had seen good reviews online about it and would only need an injection once every three months. A nurse visits Hannah’s house to give her the injection, but other people may have to do the injections themselves or get a family member to help. Megan worried about the injection in the lead up to “the needle day”. She was 15 when she had them and thinks it would have been even more distressing to have when she was younger.
Both Megan and Hannah started biological systemic medicine when other treatments (like steroids and non-biological systemic medicine) hadn’t worked or they had to stop taking them because of side effects. Hannah took a big role in deciding which kind of biological medicine to try. She researched about it on psoriasis forums, something which her dermatologists were interested to hear about. 

For Hannah and Megan, biological injections worked well for their psoriasis. Hannah finds the treatment less time-consuming than applying topical medicines or going to frequent phototherapy sessions. She only has to have a blood test once every three months followed by the injection a fortnight later. Hannah says it’s “a weight off my mind” because “I hardly think about psoriasis at all and it’s really nice to not have to”.
Megan had some side effects from biological medicine injections, such as headaches, feeling sick and tiredness. Side effects like these and others, such as damage to the liver, meant that some people stopped biological medicines and opted for different treatments. Hannah didn’t talk about having side effects like these from having ustekinumab injections, but she mentioned others risks and concerns like:
  • possible damage to the immune system (although she says she’s not felt ill)
  • being unable to have live vaccines
  • needing to stop taking the medicine well in advance of becoming pregnant


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