How Injectable Drugs Treat Psoriasis

• Topicals which include creams and ointments
• Phototherapy or light therapy
• Systemic treatments which include injectable treatments

Most of the injectable treatments for psoriasis are something known as biologic drugs or biologics. These drugs target the immune system to help alleviate some of the symptoms of psoriasis. The drugs can be referred to as "systemic" treatments because they target parts of the immune system, as opposed to something like an ointment which can be used for symptoms on just specific areas of the skin.

How Can Injectable Drugs Help Treat Psoriasis?

There are several drugs available to help alleviate symptoms of psoriasis, including injectable drugs that target different proteins in the immune system. They work by targeting and blocking molecules in the body that could be causing outbreaks.

"All of these are injections which are approved for psoriasis … some of them are also approved for psoriatic arthritis," Dr. Khattri explains. Psoriatic arthritis can cause swollen, painful joints and other symptoms that are typical of arthritis, alongside more typical symptoms of psoriasis.

Biologic medications, also known as Biologics, are typically prescribed after first-line treatment for psoriasis fails. Although they're considered to be safe, patients should still be monitored regularly as they carry a risk of suppressing the immune system and causing infections. Furthermore, investigational studies should be carried out to determine their long-term safety.

Types of Injectable Biologics

There are three main categories of biologics used to treat psoriasis, according to Dr. Khattri. These include:

• Injections that target and block TNF, a pro-inflammatory molecule that the body may be producing too much of when a person has psoriasis (includes drugs like Humira, Cimzia, and Enbrel)
• Injections that target and block IL-17, another pro-inflammatory molecule that could trigger psoriasis symptoms (includes drugs like Cosentyx, Taltz, and Siliq)
• Injections that target IL-12 or IL-23, which are also proteins linked to psoriasis symptoms (examples of these drugs include Tremfya and Ilumya)

Even though biologics have proven to be very effective in treating patients with moderate-to-severe psoriasis and psoriatic arthritis, the biggest concern remains with the increased risk that patients can develop serious infections while being on the medication (including Tuberculosis).

Other side effects can include the following:

• Allergic reactions on the skin as a result of the injection
• Headaches
• Flu-like symptoms (like fever, chills, cough, sore throat, fatigue, and runny nose)
• Urinary tract infections
• Upper respiratory tract infections

Nevertheless, it's important to note that each of these biologics will come with a list of specific side effects that need to be discussed by your doctor first before initiating treatment. You should also share with your doctor any side effects, discomfort, or questions that you may have.

How are Injectables Given?

Because psoriasis is a chronic condition, injectables to treat the disease are not a "one and done" thing, as Dr. Khattri puts it. How often you need to take the drugs will depend on what type you are getting, your symptoms, and some other factors like your overall health.

Some injectables must be administered by a doctor at their office, while with others, patients can be taught how to inject themselves at home. Obviously, administering the drugs at home is easier, but seeing a doctor regularly for injections does have other benefits like giving the doctor the opportunity to monitor symptoms and side effects.

Moreover, these injections can be administered by either getting a shot or through an intravenous (IV) infusion.

How Often Do You Get Injections for Psoriasis?

How often injectables are given will depend on the type and the individual patient; some are needed weekly while others can be given every few months.

While getting the injection every three months obviously sounds better than a weekly trip to your doctor's office, how often a patient needs the drugs can vary a great deal.

"The decision to treat a patient with a biologic is based on what kind of psoriasis they have involved, whether they have other conditions like psoriatic arthritis or inflammatory bowel disease or whether they have scalp, genitals, nails, palms, and souls [affected by psoriasis]."

How Long Can You Stay on Biologics Treatment for Psoriasis?

According to the American Academy of Dermatology Association, it's generally acceptable to stay on biologics treatment indefinitely as long as you follow up with your doctor regularly to monitor and manage your condition.

Dr. Khattri explains "These injections are something that you'd have to be on as long as it's needed Or as long as it's efficacious for you in terms of treating your psoriasis. Different biologics have different injection schedules. You have some that are every week, others that are every other week, and then you have some that are once a month or every three months."

Psoriasis Treatment Injection Cost

Biologics can be very expensive and are not always covered by insurance. In fact, according to a study published in the American Journal of Pharmacy Benefits in 2018, biologics treatment for psoriasis posed a substantial economic burden. They compared the cost of phototherapy treatment and several types of biologics medications (adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), ustekinumab (Stelara), and secukinumab (Cosentyx)) over a period of 3 years for patients with moderate to severe plaque psoriasis.

The results revealed that Secukinumab (Cosentyx) is the most expensive biologic with a 3-year cost of $182,718 compared with a 3-year cost of $5,000 for phototherapy.

Other Psoriasis Medication Injections

Aside from biologics, other types of psoriasis injectables can be used to reduce the inflammatory effect brought on by the immune system, decrease pain, and help keep damaged tissues to a minimum. These include the following options:

Steroids. These injections have a very good chance to alleviate pain, tone down flare-ups, and improve function due to their resemblance to the cortisol hormone which provides anti-inflammatory functions in the body. Examples of these injectable drugs include cortisone, prednisolone, and methylprednisolone.

Steroids can either be taken as an oral medication or administered through injections, they can also be taken alone or combined with other treatments. Your doctor will decide whether you should take steroids or not and will know the appropriate dosage and form that's best suited for your case.

As with any drug, steroids have some risks and benefits that will doctor can help explain to you. Some side effects that can be caused by steroids injections:

• Infections
• Allergic reactions
• Bleeding
• Skin changes
• Bone weakness and tendons

Methotrexate. This is a strong medication that's used to treat adults with severe psoriasis by combating the overbearing effect of the immune system which causes symptoms of psoriasis and psoriatic arthritis. It comes in many forms like injections and pills, and typically shows improvements between 4 to 6 weeks. However, they don't work for everyone. They can cause the following side effects:

• Loss of appetite
• Hair loss
• Headaches
• Fatigue or tiredness
• Mouth sores
• Decreased urination
• Swelling of gums
• Serious effects on major organs (liver, lung, or kidneys)

Additionally, pregnant, and breastfeeding women are prohibited from using methotrexate. Thus, it's important to ask your doctor whether methotrexate is the best treatment for you.

Questions to Ask Your Doctor

• Are injectables a good option for my particular type of psoriasis?
• Can the drugs be administered at home, or will I need to come to your office?
• Is it safe for me to take biologics?
• How long will I need to take biologic treatment?
• What side effects should I be aware of?
• Are there other treatment options that may be more effective?
• What do you recommend I should do to improve the quality of my life with this condition?
• Is there anything I should or shouldn't do to better manage my condition?
• How often should I follow up with you about my condition?

The Bottom Line

Psoriasis and Psoriatic arthritis are considered chronic health conditions for which there's no cure. However, there are various treatment options to manage and control the symptoms and those include injections (biologics or non-biologic), and oral and topical medications. Unlike other treatment options, biologics target certain parts of the immune system that cause the symptoms of psoriasis, rendering it the most effective.

While biologics can be a great option for some people with psoriasis, they are expensive and can also cause side effects like headaches, flu-like symptoms, or reactions at the injection site and they may not be effective for all patients.

The good news is, there was a recent FDA approval for an oral drug called SOTYKTUâ„¢ (deucravacitinib), which is currently top in its class for many plaque psoriasis sufferers preferring an oral option vs. an injectable. Plaque psoriasis is one of the most common types of the skin condition.

“Deucravacitinib has no box warnings, and very good efficacysimilar to biologics,” says Dr. Mark G. Lebwohl, Dean of Clinical Therapeutics at the Kimberly and Eric J. Waldman Department of Dermatology at the Icahn School of Medicine at Mount Sinai. “Great efficacy without having to worry about side effects as much as you do with the other drugs.”

Untreated plaque psoriasis can damage interior organs, not just the skin, not just psychological. “Patients with bad psoriasis have an increase in heart attacks, increase in a form of arthritis called psoriatic arthritis, and it affects may other organs as well. So if patients have symptoms of psoriasis, they should not be ignored, they should be treated,” Dr. Lebwhol tells SurvivorNet.

While it can be very stressful having to deal with psoriasis and its physical and mental repercussions, just know that there are many options to help treat the disease. While we like to provide hope and help inform you of your options, your doctor can help guide you to which treatment might be best for you. Take control of your suffering and make an appointment today.

Learn more about SurvivorNet's rigorous medical review process.