Biologic Drugs for Psoriatic Arthritis

One common treatment for psoriatic arthritis (PsA) is disease-modifying anti-rheumatic drugs (DMARDs). DMARDs reduce inflammation. They can also help prevent long-term joint damage, which can cause disability.

There are different types of DMARDs. These are:

• Traditional (or non-biologic)
• Biologic
• Target-specific

Biologic DMARDs (or “biologics”) are often used in moderate-to-severe PsA. Biologics are also used when a person’s PsA has not improved with other treatment options. These drugs can be used on their own or alongside other PsA treatments like phototherapy.^1,2

How do biologics treat psoriatic arthritis?

Biologics are drugs that have specific targets in the body. They are proteins made in a lab from living cells. The living cells can come from a variety of sources. Some are human. Others come from animals like mice. Biologics can also come from mixed sources. When the types of living cells are mixed, the result is a chimeric biologic.

In PsA, biologics target specific parts of the immune system. Some target cytokines. These include tumor necrosis factor-alpha (TNF-alpha), interleukin 17 (IL-17) or interleukin 23 (IL-23). Cytokines are proteins that play a role in the inflammatory response. When they are blocked, inflammation may be slowed or stopped. This is helpful for autoimmune or inflammatory conditions like PsA. Decreasing inflammation can help improve symptoms and prevent further joint damage.

Other biologics target T cells and block their activation. T cells are immune system cells that also play a role in inflammation. Biologics can also be used for other inflammatory conditions. This includes rheumatoid arthritis, plaque psoriasis, and ankylosing spondylitis.^1-7

Examples of biologic medications for PsA

A variety of biologics exist for PsA. These can be separated into groups based on the specific target in the pathway to inflammation.

Examples of biologics that target TNF-alpha include:^1,2

• Cimzia^® (certolizumab pegol)
• Enbrel^® (etanercept)
• Humira^® (adalimumab)
• Remicade^® (infliximab)
• Simponi^® (golimumab)
• Simponi Aria^® (golimumab)

Examples of biologics that target IL-17 include:^1,2

• Cosentyx® (secukinumab)
• Taltz® (ixekizumab)

Examples of biologics that target interleukin 23 (IL-23) include:^1,2

• Tremfya^® (guselkumab)
• Stelara^® (ustekinumab; also targets IL-12)

The biologic Orencia^® (abatacept) is unique. It targets T cells.^1,2

What are the possible side effects of biologics?

Side effects can vary depending on the drug you are taking. Some of the most common side effects include:^3-7

• Upper respiratory infection
• Sinus infection
• Runny nose
• Headache
• Rash
• Diarrhea
• Nausea
• Injection site reactions (redness, itching, swelling of the injection site)

These are not all the possible side effects of biologics. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment.

Things to know about biologics

Because they decrease inflammation and immune system response, biologics can increase the risk of infection. Serious infections can be caused by fungi or bacteria and become life-threatening. Do not start taking a biologic if you have an active infection or are currently pregnant/breastfeeding.

Before you start a biologic, your doctor may test you for tuberculosis (TB) and hepatitis B. Starting a biologic when you have TB or hepatitis B can lead to severe infection. If you are at high risk for infection on a biologic, you may need to take other drugs alongside it. If you get fevers, chills, muscle aches, or other symptoms of an infection, talk with your doctor right away.

In some cases, biologic drugs may impact a person’s blood cell counts or increase the risk of cancer. Your doctor can tell you if your drug has these risks.

Before beginning treatment for PsA, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs, since many biologics can interact with other drugs. Although it is rare, serious allergic reactions can occur with biologics. Tell your doctor about any allergic reactions you have had to drugs in the past. Signs of an allergic reaction include hives, trouble breathing, abdominal pain, and swelling of the face, tongue, or lips.

Biologics can also impact a person’s ability to safely receive live vaccines. However, most vaccines are not live and can still be taken. Talk with your doctor before starting a biologic if you have recently received or will soon receive a vaccine.^3-7