6 Things to Know When Starting Biologics for Psoriasis
Giving your dermatologist the greenlight to put you on a biologic for your psoriasis is a big decision. Our experts share some of the things to know before starting.
Your doctor just gave you the option of treating your psoriasis with a biologic. The medicines are made from protein-based molecules found in living things (including humans, animals, and microorganisms) and act like antibodies. Conventional psoriasis drugs are made through a chemical process, while biologic agents are created from bacterial strains. And unlike systemic drugs that affect the entire immune system, biologics target only certain proteins called T cells that are one of the main catalysts for developing psoriasis.
So, you sit there listening as your doctor talks about scheduling, dosage, refrigeration, combination therapy, injection site (belly? thigh? arm?), and your head starts to spin. Do I really need one? Figuring out whether you should begin biologics will be a decision that you make with your doctor. To help you on your journey, here are six things to know before setting off.
1. Talk to Your Dermatologist to Understand How Long You Will Be on It
The main thing to remember about biologics is that they take time to work. It varies from person to person, but in general you’ll see improvements in 12 weeks, with results lasting several months. Someone with a mild case of psoriasis may see symptoms taper off in as fast as a week. “Biologics is not a cure for psoriasis but rather works to treat and prevent its symptoms,” says Sheel Desai Solomon, MD, a dermatologist in Raleigh, North Carolina. “Most patients with moderate-to-severe psoriasis who take biologics for psoriasis agree it is the most effective treatment for the disease.” The longer you take a biologic continuously, the better it works for you. Patients will often take a biologic for many years until the treatment loses its effectiveness. Then, your doctor may switch you to another biologic.
Many people want to stop just because their psoriasis has cleared, but that’s the worst thing you can do.With most biologic agents, you don’t want to “stop and start” treatments, says Larry F. Eichenfield, MD, professor of dermatology and pediatrics, at the University of California, San Diego School of Medicine and Rady Children's Hospital. “As the body can develop antibodies to the drug which may decrease the drugs ability to clear the psoriasis. So, if it’s working after the initial few months of treatment, the plan for how long to stay on it is something to discuss with your dermatologist.”
2. Make Sure It Fits Your Schedule
Planning ahead is crucial as most biologics are administered once a week to every three months at an infusion center via IV drips and some are at-home injections that patients can self-administer. You should try to not miss doses, but life happens. If you inject the medication yourself at home but happen to miss your scheduled day, take it as soon as you remember and then return to your regular injection schedule, says Dr. Solomon. “Whatever you do, do not double up on your dosage to make up for the missed one.” Skipping an injection or infusion is not dangerous, if you are not making a habit it out of it. “Missing one injection can make psoriasis symptoms return until the next administration,” says Dr. Solomon. “Constantly starting and stopping the biologic injections can put you at risk for developing an infection.”
3. Understand the Side Effects
All medications have side effects, including biologics. The most common side effects are the discomfort and local reactions from injections or infusions like swelling, redness and itching, says Dr. Eichenfield. But different biologics come with different concerns and issues. Some of these side-effects include bacterial infections like staph and fungal infections, pneumonia, or tuberculosis.Consult with your doctor if you are concerned about the effects a treatment has on you. Note your symptoms as soon as you experience them, in order to share with your doctor during your consultation.
4. Be Clear on What “Combo Therapy” Is
“One of the conveniences of biologic therapy is that they can make patients clear, or almost clear, as a single therapy, bypassing the need for creams and ointments or other oral of injectable medications,” says Dr. Eichenfield. “But [some] individuals may need to combine a biologic with other topical or systemic medications to adequately control psoriasis, and/or psoriatic arthritis, which is seen in a subset of skin psoriasis patients.” Combining treatments promotes the efficacy of the treatment while lowering the dose, notes Dr. Solomon. This helps to decrease unwanted side effects that, for some people, can make treatment unsustainable for the long run.
5. Talk to Other Psoriasis Patients
The best people to surround yourself with are those who may have gone through a biologic treatment but understand your journey will be completely different. “For most patients, making the decision becomes clear and easy with some good discussions with their health care professional, but even more so when supported by family, friends, medical professionals and others who have also been through the psoriasis journey,” says Dr. Eichenfield.
This is vital, not only while you’re starting biologics but throughout your entire psoriasis journey. You can connect with real-life psoriasis patients who know and understand your struggle. Including them in your support system with your family and friends will be the best decision you can make. The HealthCentral Psoriasis Community on Facebook, the National Psoriasis Foundation One-to-One program and Overcoming Psoriasis group on Facebook are great places to start.
6. Keep a Journal
If you haven’t already, start journaling now. This will help you understand how your body is responding to the treatment. You can also jot down any questions or concerns you might have that your doctor can answer at your next appointment. Check out the Day One journal app to get you started. On Day One you can include upload photos, drawings and audio recordings to bring your journal to life. The opposite of a physical journal that you might carry around (or leave somewhere), with the Day One app you have it on you (on your smart phone or device) whenever a thought or feeling comes to mind.
Dr. Eichenfield suggests thes other important aspects psoriasis patients can record in their journals:
Assessing the amount of psoriasis or coverage area
The location of psoriasis
The therapies tried
How psoriasis impacts mood, sleep, work, school, athletics and leisure activities