When Howard Chang, 50, first learned about biological treatments for psoriasis nearly 20 years ago, he was eager to try them. They are now a mainstay in his comprehensive treatment plan.
Chang was first diagnosed with psoriasis at around the age of eight. Try lots of different treatments, including tars, light therapy, topical creams and ointments, steroids, and oral medications.
“I was definitely always on the lookout for the next new treatment, because it was very difficult for me to find anything that would work,” Chang says.
He hoped that biology would provide much-needed relief.
What is biology?
Biologics — often called biologics or biologics — work by changing parts of your immune system. Usually you give yourself a chance. But some are given through an IV in your doctor’s office. The Food and Drug Administration approved the first two biologics for psoriasis in 2003. Now there are several options.
They are generally prescribed for people with moderate to severe psoriasis, based on the amount of skin affected. But doctors also consider how psoriasis will affect a person’s life when making the decision, says Malini Fowler, MD, a board-certified dermatologist in San Antonio, Texas.
“There is no filter for cookie cutters,” Fowler says. “Even if someone has a mild illness, it’s probably still a candidate for biology, depending on how it affects their life.”
These medications may also do more than just clean your skin. They can help protect your heart, joints, and other parts of the body from inflammation.
“When we talk about the use of biopharmaceuticals, it is a systemic drug that treats (people) from the inside out, reduces psoriasis on the skin, and hopefully helps treat inflammation from the inside as well,” Fowler says.
What are the pros and cons of biology?
Chang read about how the drugs work, and the potential side effects and risks when considering biology for the first time.
“Putting something into your body by injection is something you should consider, particularly how it affects your immune system,” Chang says.
Next, talk to his or her dermatologist.
“It’s important to have a dermatologist who understands medications, collaborates, and communicates with me as a person,” Chang says. “Together we are working on a plan.”
While biologic medications can relieve psoriasis symptoms, there are potential risks, as with any medication. Some of them can increase your odds of developing inflammatory bowel disease and cancer.
“You need to check if you have underlying cholesterol issues or high blood pressure,” Fowler says. “Every biologic drug is a little different; most of them have a different mechanism of action with different safety profiles.”
It is important that you tell your doctor about any other conditions you may have, so they can be sure that the biological substances will not interfere with them or any medications you are taking.
Which biologic is most effective for psoriasis?
Zhang has tried six biologic drugs since 2003. One helped for about 8 years, but had to switch the rest because he couldn’t stand the side effects of some of the drugs, or they stopped working after a certain amount of time, or they just didn’t work at all.
While Chang says he knows many people who have achieved healthier skin with biopharmaceuticals, the treatment has not been successful for him.
“I’ve never been so clear,” he says. “It is not a cure. There are still triggers that can cause a flare-up.”
Finding the right probiotic for you can be emotionally exhausting.
“It’s a rollercoaster ride. You’re still hoping it works, and you’re waiting to get started,” Chang says. And then if it doesn’t work out for you, it could be a huge disappointment.” “Especially since then [psoriasis] It has a huge impact on my life. Sometimes, I feel like I can’t fully function because I feel all this physical discomfort when I’m running, working, learning, meeting people. I just want to be comfortable.”
Fowler likes to give Biology 3 months to run its course.
“Not every medication will work for every[person]but it’s also important to stick with the medications and give them a chance to see if it helps them,” she says. “I tell them, ‘If this doesn’t work, we’ll move on to the next stage. We’ll find the right medication for you, but it might be a bit of trial and error.”
Can I take biologic medicines with other treatments?
Chang continues to use other psoriasis treatments, including topical creams and light therapy.
“I feel better about things in general [with biologics]that I don’t have to do everything perfectly,” he says. “It feels a little better knowing I have a drug running in the background.”
He knows that stress management, exercise, and eating healthy are essential to prevent flare-ups. They do the same for metabolic syndrome, a group of conditions linked to stroke, type 2 diabetes, and heart disease. People with psoriasis are more likely to develop metabolic syndrome.
In addition to regular appointments with a dermatologist while on biology, Fowler suggests keeping your primary care doctor updated, getting blood tests every year, and seeing a rheumatologist every 6 months.
“I also routinely ask patients about joint pain, because about 30% [of people with psoriasis] You will get psoriatic arthritis.
What is the biggest challenge in taking biopharmaceuticals?
One hurdle is learning how to inject the drugs yourself.
“I think I injected myself a thousand times more,” Zhang says.
Fortunately, the number of injections is significantly lower with newer biological drugs. Chang says he used to have to inject himself twice a week, but some of the injections can now be weeks or months apart, depending on the medication.
Chang created a routine to follow when giving himself an injection, from washing his hands and putting on all the materials, to making sure he had something to watch in the background.
“It calms me down to have a routine,” Chang says. “[Injecting yourself is] Something you’re not quite used to, but you’re getting skilled at.”
Another hurdle could be getting approval from your insurance company to cover different biopharmaceuticals.
Chang hopes that biological treatments for psoriasis and other options will continue to improve.
“It’s just a time to be really optimistic as someone with psoriasis,” he says. “With all the research, medication, and endorsements, we have options and more to come.”