1. Which biologic is most likely to help me?
3. How often do I take the biologic, and what should I do if I
miss a dose?
4. Should I be worried about my risk of infection?
5. I heard biologics come with an increased risk of cancer,
so why should I take them?
6. How much do biologics cost? Are they covered by
2. I’m afraid of needles. Does it hurt to take a biologic?
7. What are biosimilars? Are they the same as generics?
8. Will I continue using phototherapy, topical therapy, or
other medications to treat psoriasis while on biologics?
9. I'm having self-esteem issues from psoriasis, and I heard
biologics might help. How?
9. Will I have to take these medications forever?
8. Will I be able to afford this medication?
7. JAK inhibitors are still pretty new – are you sure they’re safe?
6. I read that JAK inhibitors increase the risk of blood clots. Should I be worried?
5. Can taking a JAK inhibitor cause cancer?
4. Why do I need to get certain vaccinations first?
3. Will taking a JAK inhibitor shut down my immune system?
2. If one JAK inhibitor doesn’t help me, does that mean none of them will?
1. Which JAK inhibitor is most likely to help me?
With so many biologic drugs on the market, you might be wondering where to start. The truth is, there’s no guaranteed way to know which biologic will be most effective for you. Your doctor will guide you on where to start for your particular situation. And if one biologic doesn’t work, you can switch to a different one until you and your doctor find the biologic that best controls your psoriasis.
While self-injections or IV infusions can take getting used to, most patients find them to be tolerable and feel that the outcome of fewer or no plaques outweighs any hesitation. Of course, with needles, there is the possibility of mild pain, but the self-injections are usually administered in the abdomen, where there is more adipose tissue (fat), which should make it less painful. If you do experience any pain from the injections, it is a brief sensation that shouldn’t last longer than a few seconds.
If you’re prescribed a self-injectable biologic, your doctor or nurse will show you how to do it at home. Most of the injectors are user friendly and have needle safety mechanisms to prevent accidental injuries.
2. I’m afraid of needles. Does it hurt to take a
The frequency depends on the type of biologic your doctor prescribes. Some self-injected biologics can be done weekly or biweekly, while infusions may start at every 4 to 6 weeks and then switch to every 8 to 12 weeks.
If you miss a dose, call your doctor and follow their instructions on when to take the next one.
3. How often do I take the biologic, and what
should I do if I miss a dose?
Since biologics suppress parts of the immune system, there is an increased risk of infection. Your doctor will be monitoring you for such risks. Most patients find that the benefits outweigh the risks of biologics.
4. Should I be worried about my risk of infection?
The risk is minimal, and multiple studies have shown biologics to be safe in terms of cancer risk. According to an analysis of 2014 data from PSOLAR (Psoriasis Longitudinal Assessment and Registry) published in the Journal of Drugs in Dermatology, in the 12,093 patients enrolled, biologics were not found to increase cancer risk.
Even for people with psoriasis and existing or prior malignancies, the benefits of biologic therapy often outweigh the negligible cancer risk, according to a review published in the International Journal of Dermatology in 2016. In those cases, coordinated care with an oncologist is recommended.
According to a review and meta-analysis of 112 studies published in the February 2020 issue of JAMA Dermatology, the overall risk of cancer is slightly increased in patients with psoriasis, particularly lymphomas and keratinocyte cancer. However, there was no increase in cancer risk seen among psoriasis patients who were treated with biologics.
5. I heard biologics come with an increased risk
of cancer, so why should I take them?
Biologics are expensive, but they are pretty well covered by insurance. Your dermatologist can discuss the cost with you, and it’s always a good idea to check your plan’s coverage with your insurance provider.
You can also check the drug company’s website for PAPs (patient assistance programs), which can provide financial assistance. Another smart idea: Ask your doctor for samples to try before you purchase the drug.
6. How much do biologics cost? Are they covered
Biosimilars are modeled after an existing FDA-approved biologic with “no clinically meaningful differences,” according to the FDA. Though people may think of them like a generic drug, they cannot be labeled generic versions because they are not identical to the original drug — the production of a biologic is such a detailed, intricate process that it is impossible for a different company's lab to duplicate the product exactly. However, a biosimilar will generally bind to the same receptors and work on the same pathway as the name-brand biologic it is mimicking.
7. What are biosimilars? Are they the same as
Possibly. Biologics treat psoriasis from the inside, and add-on therapies, such as a short-term topical corticosteroid, can help improve psoriatic plaques even more. Biologics can also be combined with traditional systemic medications. However, they have been shown to clear psoriasis on their own, so you may not need additional treatments.
8. Will I continue using phototherapy, topical therapy, or other medications to treat psoriasis while on biologics?
Whether your psoriasis is mild, moderate, or severe, poorly treated psoriasis can take an emotional toll, leading to isolation, insomnia, anger, and depression, according to the National Psoriasis Foundation. They also note that patients exhibited a higher quality of life and lower levels of depression after taking a biologic.
When psoriasis is well controlled, feelings of self-consciousness might subside along with the plaques, but if you continue to experience depression or anxiety, talk to your doctor. You may benefit from talking to a mental health professional, who may prescribe an antidepressant or other medication. Also, consider joining a support group where you can talk to other people going through similar issues.
9. I'm having self-esteem issues from psoriasis, and I heard biologics might help. How?