Biologic Medications for Psoriatic Arthritis
Disease-modifying anti-rheumatic drugs (DMARDs) are effective at treating psoriatic arthritis (PsA) because they reduce the inflammation and prevent the long-term joint damage, which can cause disability. There are different types of DMARDs: traditional (or non-biologic), biologic, and target-specific.
Biologic DMARDs (or “biologics”) are used to treat people with moderate-to-severe PsA whose disease has not responded adequately to other types of treatment. Biologic DMARDs are types of therapies that include bioengineered proteins that mimic functions found in specific human genes or cells. They work by interfering with specific substances in the immune system to reduce or better regulate the inflammatory responses that cause PsA and psoriasis symptoms. Biologic DMARDs include:
Cimzia is a tumor necrosis factor (TNF) inhibitor. TNF is one of the chemical proteins involved in the inflammatory response, which is overactive in PsA. TNF inhibitors like Cimzia block TNF and reduce the symptoms of PsA and prevent future joint damage. Cimzia is a PEGylated TNF inhibitor. PEG is polyethylene glycol, a substance that is attached to a protein to make it stay in the body longer.1,2
The most common side effects experienced by patients taking Cimzia include redness or pain at the injection site, upper respiratory infections, rash, and urinary tract infections. Cimzia can cause serious side effects including new infections or worsening of infections, seizures, bruising, bleeding, rash, blistering skin, hives, itching, difficulty breathing or swallowing, vision problems, weakness in the arms or legs, or dizziness. These symptoms are serious and should be given immediate medical attention. Patients who take Cimzia may be at a greater risk of developing lymphoma, leukemia, skin cancer, or other cancers.1
Cosentyx is a type of medication called an interleukin 17-A (IL-17A) blocker and works by blocking the function of the IL-17A proteins, which contribute to the excess inflammation that causes psoriatic symptoms. Cosentyx is taken long-term through injections and can help slow the joint damage caused by PsA.3,4
Common side effects include cold-like symptoms, diarrhea, and upper respiratory infection. Severe side effects that constitute medical attention include lightheadedness, swelling of the face, mouth or throat, difficulty breathing, tightness in the chest, and rash. These may be signs of an allergic reaction. Additionally, some people with inflammatory bowel disease experienced worsening symptoms on Cosentyx. Some patients with active infections or certain medical conditions may not be able to take Cosentyx.3
Enbrel is a TNF inhibitor that helps reduce swelling, relieve joint pain and stops further joint damage in people with PsA.5
People with certain other medical conditions cannot take Enbrel. Common side effects include irritation upon injection site, headache, and upper respiratory injection. More serious side effects that are monitored for throughout treatment include nervous system problems, blood problems, heart failure, allergic reaction, worsening psoriasis, and autoimmune reactions.4 Enbrel can increase the risk of serious infections, like tuberculosis, and certain cancers, like lymphoma.5
Humira is an injectable medication that is a TNF inhibitor, which reduces overall inflammation and psoriatic symptoms and prevents long-term damage from disease progression.6
Common side effects with Humira include redness or bruising at the injection site, nausea, headache, upper respiratory infection or back pain. Some side effects are serious and require immediate care by a physician, including numbness or tingling, problems with vision, weakness in legs, chest pain, shortness of breath, rash, new joint pain, hives, difficulty breathing or swallowing, dizziness, unusual bruising or bleeding, or signs of infection, such as fever, sore throat, or chills. Patients who take Humira may be at a greater risk of developing lymphoma, or other cancers.6
Orencia works by inhibiting the activation of T-cells, a type of lymphocyte (white blood cell) that is actively involved in the inflammatory process.7
Common side effects with Orencia include colds, sore throats, upper respiratory tract infections, and nausea. Orencia may cause serious side effects, including allergic reactions, pneumonia, sepsis, hepatitis B reactivation, or certain cancers, including lung cancer and lymphoma.7
Remicade is a TNF blocker, TNF is a protein secreted by cells that is responsible for the release of cytokines which activate the body’s inflammatory response. The medication blocks the function of TNF and the cytokines which reduces the inflammation that causes psoriatic symptoms.8
The most common side effects experienced by patients taking Remicade include respiratory infections, headache, fever, cough, nausea and stomach pain. More serious side effects include heart failure, liver problems, blood issues, nervous system problems, allergic reactions, lupus-like symptoms, and worsened psoriatic symptoms. In addition, Remicade may increase the risk of developing certain types of cancer and infections. People taking certain medications and/or who have specific medical conditions may not be able to take Remicade.8
Simponi and Simponi Aria are TNF inhibitors. Simponi is a once-a-month injection, and Simponi Aria is an infusion that is given every 8 weeks after the first two monthly doses.9,10
The most common side effects experienced with Simponi are dizziness and irritation at the injection site, including redness, itching, bruising, pain or swelling. Some side effects can be serious and require immediate medical care, such as chest pain, shortness of breath, swelling of the ankles or lower legs, vision changes, weakness or numbness of arms or legs, pain in the upper right part of the stomach, easy bruising or bleeding, rash, sensitivity to sunlight, hives, or difficulty breathing or swallowing. Patients who receive Simponi may be at a greater risk of developing the skin cancer melanoma, lymphoma, leukemia, or other types of cancer.9
Stelara is classified as an interleukin inhibitor and works by targeting interleukin (IL)-12 and interleukin (IL)-23. These cytokines, or chemical messengers, are critical to the inflammatory process of the immune system.11
Stelara may cause side effects, including headache, dizziness, tiredness, back pain, upper respiratory infection, runny nose or redness and irritation at the injection site. Some side effects are serious and require immediate medical care, such as seizures, confusion, vision changes, feeling faint, difficulty breathing, tightness in the chest or throat, rash, or swelling of the face, tongue or throat. Ustekinumab may increase the risk of developing cancer.11
Taltz selectively binds and neutralizes interleukin 17A (IL-17A) cytokine proteins that are involved in the inflammatory response. IL-17A promotes joint damage and inflammation specifically, which leads to the painful and uncomfortable symptoms of PsA. By binding to these proteins, Taltz can effectively reduce the rate and severity of this immune system action.12
Because Taltz affects your ability to fight infections, those on the medication can be more susceptible to certain illnesses. The most common side effects found with Taltz were common colds, upper respiratory infections, nausea, ear infections, or redness and irritation at the injection site. Rare side effects include the worsening or development of irritable bowel syndrome, as well as potentially worsening depression.12
What is Tremfya?
Tremfya inhibits IL-23, which means it works to block the action of this protein in the body. By blocking this, inflammation is decreased, improving symptoms of psoriatic arthritis. The active ingredient in Tremfya is guselkumab, a selective IL-23 inhibitor.
The most common side effects of Tremfya include upper respiratory infections, joint pain (arthralgia), fungal skin infections, headache, diarrhea, herpes simplex infections, injection site reactions, stomach flu (gastroenteritis), and bronchitis.
Biologic DMARDs and psoriatic arthritis
Because biologic DMARDs affect the immune system, they can put a person at an increased risk of infection. People who are taking a biologic medication should carry a biological therapy alert card with them at all times to alert healthcare providers about their biological medication. This information is important so that healthcare providers can take steps to reduce the risk of infection and determine what other drugs can and cannot be given.
This list of drugs and side effects is not exhaustive. Side effects and symptoms may vary depending on dosage, frequency, and prescription of treatment.
In addition, people with PsA who are considering taking biologics should talk to their doctor about all their medical conditions, any planned vaccines (as some vaccines may not be safe to take while taking biologic DMARDs), and all medications and supplements they are taking.