Biological therapy for psoriasis

What are Biologic drugs?

Biologic drugs or Biologics or biological response modifiers wide range of products made of sugars, proteins, nucleic acids or combination of all these or may be living cells of human, animals or microorganisms.They are developedwith help of biotechnology methods. They are either administered by subcutaneous injection or infusion (Slow IV drip).Now a days few are available in tablet form also. The advantages of using biologics is that they target and block specific parts of immune system that are responsible in manifesting the symptoms of diseaseand leave other parts unaffected. This increase their efficacy and lowers incidences of side effects. Sometimes they are being used for disease for which no other treatment is available.

What is difference in biologics and other drugs?

Common drugs are made of known chemically synthesized structures but biologics are made of complex misture not easily identified. They are heat sensitive and susceptible to microbial contamination.

What are the skin diseases where biologics are commonly used ?

• Common diseases are
• Psoriasis
• Pemphigus
• Hidderinitis Suppurativa
• Alopecia Areata
• Urticaria
• Atopic Dermatitis

What is the role of biologics in treatment of Psoriasis?

Psoriasis is an autoimmune disorder in which skin cells multiply faster than normal. The biologics target the cells of immune system that are responsible for overgrowth of cells (T-cells,TNF-alpha, interleukins) and block them. These are given by subcutaneous or IV route so that they escape getting damaged by digestive juices. Biologics do not cure psoriasis but relieve you of the symptoms. As compared to medical therapy, they are more effective in clearing the symptoms. They are administered on weekly or once in two week or in gap of several weeks.

How do I know whether biologics are right for me?

Treatment with biologics is effective but is expensive and comes with its own disadvantages. Patients are encouraged to understand three major questions:

1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?

Furthermore patient should discuss with doctor every aspect of biological therapy in detail.
Following must be considered before starting the treatment.

You maybe the right candidates for biologics if:

• You have tried every other treatment but were not relieved from your symptoms.
• You had unbearable side effects from other medical therapy.
• You suffer from a condition which prevents you from taking medical treatment.
• You prefer taking fewer doses compared to daily dosing of medical therapy.
• You can afford cost of treatment.

You are not a good candidate for biologics if:

• You have tested positive for infections like, TB or HIV or have an active infection.
• You suffer from, Liver disease, cancer, heart failure or multiple sclerosis
• You are pregnant or breast feeding.
• Your Immune system is severely compromised.
• Unable to afford such expensive treatments.

How biologics are given to patients?

• Injection under skin- eg. Secukinumab
• Infusion into blood (IV)
• Oral Tablet- Tofacitinib

What are the various types of Biologics used in treatment of Psoriasis?

Biologics can be classified based on the protein they block:

• Interleukin-17 Inhibitors: E.g. Secukinumab, Brodalumab, Ixekizumab
• Interleukin-12/23 Inhibitors: E.g. ustekinumab (Stelara)
• Tumour necrosis factor alpha (TNF-alpha) inhibitors: E.g. Etanercept, Adalimumab, infliximab Certolizumab
• T-cell inhibitors: abatacept
• Interleukin 23 inhibitors: Ilumya (tildrakizumab-asmn), Skyrizi (risankizumab-rzaa) and Tremfya (guselkumab)

Based on your symptoms and requirements, your doctor will pick a right biologic drug for you.

What investigations are required before biologics therapy for skin disease?

• Routine investigation including CBC, LFT, RFT, Urine microscopy.
• Test to ruleout possibility of infections – HIV, HbsAg, TB
• Chest Xray, ECG, ECHO
• Other investigations depends on patient’s comorbidities, disease and biologic.

How scapho (secukinumab) is given to psoriasis patient?

It comes in injection form and prepared with precautions during the time of injection only. It comes as 150 mg strength injection vial. Usual dose is 300 mg per sitting but dose can be decided by treating doctor. It is given under the skin (subcutaneous) on thigh or abdomen. Initially it is given weekly for 5 weeks then monthy for 6 months. Later course of therapy depends on status of disease.

How long does it take for this medicine to show effect?

Usually most of patient start showing effect after secon dose. Till the end of weekly doses most of patient get significant improvement in skin condition. The effects may last upto 8 months to 1 year after completing 6 doses of monthly doses. The literature suggest continuing doses of medicine to maintian remission.

Which biologic is effective in pemphigus?

When conventional therapy for pemphigus like steroids and oter immunosuppresants are not effective or patient have some contraindication for any of these medicine biologics can be used. Rituximab is first FDA approved biologic therapy for pemphigus and it is highly effective. It is given as IV infusion and need basic monitoring of vitals.

What are risks and side effects of biologics ?

• Common infections- URI, pneumonia, UTI or skin infection
• Opportunistic infections- TB, Hepatitis B or deep fungal infection.
• Allergic reactions

What are the precautions to be taken while taking biologics?

Biologics lowers down your body’s defence system making you more vulnerable to infections. Watch for following signs and report to your doctor immediately if you seem to have any:

• Fever and chills
• Body aches
• Feeling unusually tired
• If you feel that symptoms of any disease which you had or is under control (remission), are remerging.

Biologics therapy available in Jaipur at Dr. Kothiwala SkinEva Clinic

Dr. Sunil Kothiwala educate patients about biologics in detail and try to make it affordable to patients in every possible way. For psoriasis scapho and for pemphigus rituximab are most coomonly used biologics at our clinic by Dr Sunil Kothiwala. We follow standarized protocols for administration of biologic therapy to minimise all the possible risk and side effects.

For more information on Biological therapy for psoriasis or to inquire about other services please contact us on 7669571405.