Biologics: Beyond the Basics

Abstract

Biologics are novel targeted therapies aimed at blocking specific cells or proteins created by the immune system that mediate the inflammatory process. Currently, the American Food and Drug Administration (FDA) has approved 12 different biologics that are administered either through intravenous infusion or intramuscularly for the treatment and prevention of psoriasis and arthritic psoriasis. These biologics categorically inhibit different cytokines, mainly IL-23, IL-17A, and IL-17F, that are activated and mediate the psoriasiform process with better long-term effectiveness and reduced side effects as compared to traditional systemic and topical steroids. The benefit of biologics also extends to a larger time interval between medication dosing as patients may achieve therapeutic levels for weeks to months before needing another dose. Transition to biologics from standard therapy should be considered for the right patients who have failed to improve, however with caution towards inherently immunocompromised patients as biologics may increase the risk of developing infections through compounded immune system suppression. This risk can be stratified with prophylactic blood tests, TB testing, and other examinations while on the biologics to ensure proper patient safety and therapeutic benefit.