Working with your doctor to weigh the risks and benefits of biologic drugs can help you make the right treatment decision for you.
Psoriasis results from an overactive immune response that causes skin cells to multiply rapidly and build up on your skin’s surface. This chronic, lifelong condition requires ongoing treatment.
For years, traditional systemic medications, which dampen that overactive immune response throughout your body, have been the standard treatment for psoriasis. But findings from a
“There is a good amount of data published on the comparative effectiveness of systemic treatments for moderate to severe psoriasis but very little on comparative safety,” said Dr. Erica D. Dommasch, MPH, the 2019 study’s lead author and a dermatologist in the department of dermatology at Beth Israel Deaconess Medical Center in Massachusetts.
Dommasch has previously consulted with some pharmaceutical companies and also received grants from them.
Despite their effectiveness, these biologic drugs are costly, which may leave you wondering whether the benefits are worth the price tag.
Biologic drugs come at a price. They tend to range in cost from $10,000 to $30,000 per year, but the most expensive options can cost more than $500,000.
“Other therapies for psoriasis are much less costly,” said Dr. Suzanne Friedler, clinical instructor of dermatology at Mount Sinai Medical Center in New York.
“The least expensive topical steroids may run in the hundreds for a year supply,” she added. “Phototherapy could cost about $5,000 for a year of therapy, and oral systemic agents could be in the low thousands.”
Some healthcare professionals have suggested that biologic drugs are expensive because patent protections are preventing many alternative drugs, called biosimilars (cheaper copies of biologics), from competing in the U.S. market.
“There is a need for further cost-effectiveness studies to determine whether the potentially superior safety profile and efficacy of some of these medications can justify the increased costs,” said Dommasch. “That said, the type of information we have presented in this study is important for this.”
“Often, a determining factor in what psoriasis treatment is chosen is what’s covered by a patient’s insurance,” Friedler added.
“As with any new medication, the initial period sees high cost because manufacturers are trying to recoup their [research and development] investment,” said Dr. Richard Torbeck, a board certified dermatologist with Dermatology Associates.
He added, “The new biologics are cost prohibitive in the early going, but there are programs from the drug companies to provide access to these potentially life-changing medicines.”
Dommasch said affordability might improve if biologics prove their cost-effectiveness, “potentially leading to a more evidence-based approach to what insurers are willing to cover.”
“However, at the present moment, people with psoriasis and their providers generally have their choice of medications restricted by what their plans will cover,” she said.
That said, many drug companies offer prescription assistance programs to help cover the cost of treatment.
A biologic is a type of drug that works by inhibiting the overactive immune response that causes psoriasis symptoms.
Conventional systemic drugs suppress the overactive immune system as a whole. Biologics are different in that they target a specific pathway in your body that leads to inflammation.
Biologics are given by injection or infusion. And they can be combined with other psoriasis treatments to help manage the condition.
Effectiveness
Findings from the
“The newer biologics are more targeted compared to the older therapies. This allows them to be more effective, sometimes reaching total skin clearance with fewer side effects. We’re less worried about immunosuppression in the patient and immunosuppression-related cancer risk,” said Torbeck, who wasn’t associated with the study.
Less risk of infection
In the 2019 study, Dommasch and her team found that people who used biologics had a significantly lower risk for infection than those who were taking the other drugs.
The researchers used data from two insurance claims databases that included more than 250 million people in the United States.
They tracked the incidence of serious infection requiring hospitalization in 107,000 people with psoriasis who had a prescription claim for one of seven systemic drugs (those that affect the whole body) that were approved to treat moderate to severe psoriasis.
The drugs included acitretin and methotrexate. The researchers also looked at the biologic drugs adalimumab, etanercept, ustekinumab, and apremilast.
“One of the side effects that patients and physicians are the most concerned about with these medications is a potential increased risk of infection,” Dommasch said.
But the study did have limitations. The researchers were unable to identify many users of infliximab, which is given as an intravenous medication.
“Therefore, it’s often not coded in databases as a prescription fill, which is how we identified users of the systemic medications,” Dommasch noted. “We also weren’t able to look at baseline psoriasis severity across the different medications, which also may impact the risk of infection.”
Other benefits of biologics
According to Torbeck, biologic drugs have fewer side effects — and this makes them, at times, a better choice and a more enticing option.
“Some of these new biologics don’t require the same level of lab monitoring, purport fewer lost days of work, no need for infusions, and provide almost totally clear skin,” he said.
And various types of biologics are available, with each targeting a slightly different pathway involved in the overactive immune response. So if one doesn’t work, there are others you can try.
Biologic drugs also help treat psoriatic arthritis, a type of arthritis that’s common in people with psoriasis. Additionally, by lowering levels of inflammation in your body, these drugs help reduce the risk of related health conditions such as diabetes and heart disease.
Biologics are typically prescribed to treat moderate to severe cases of psoriasis.
Most people who have psoriasis need to try other therapies to see whether they work before their prescription benefits will cover the cost of biologic treatment.
“I’ll usually start them on a topical steroid with and without topical vitamin D,” said Torbeck. “If it’s moderate to severe with or without arthritis, I’ll discuss biologics, phototherapy/lasers, and systemic therapies. I take all this and the patient’s desires into consideration.”
He added, “For topical steroids, there is a great therapeutic window, but there are side effects like thinning of the skin, steroid withdrawal symptoms such as skin worsening when not using treatment, and you can get acne.”
This is where biologics have a distinct advantage and why some people may want to consider them.
Even though biologic drugs are considered safe, they come with some risks and side effects.
People who take injectable biologics may experience pain or skin reactions at the injection site. A small percentage may experience an allergic reaction.
Biologics also pose a risk of infection, though it is lower than the infection risk seen in systemic medications for psoriasis.
Before prescribing a biologic, your doctor will review your medical history and do necessary testing to make sure it’s safe for you to take.
And there’s still a lot that researchers are looking into when it comes to treating psoriasis with biologics.
“A counterpoint to look at is if there’ll be fewer hospital visits, quality of life issues, testing, and other disease-related factors with these newer medications,” Torbeck said.
Research is showing that biologic drugs, a newer form of psoriasis treatment, are safer than conventional systemic medications.
In many cases, these drugs are also more effective at clearing up disease symptoms.
These new drugs are expensive and are not always covered by insurance, but experts believe the prices could decrease in the years ahead. And you may be able to work with the drug company to help lower your out-of-pocket treatment costs.