Injections

The new kids on the block in psoriasis treatments are the drugs commonly referred to as the ‘biologics’. These medications have been developed to more specifically target those parts of the immune system that are overactive in patients with psoriasis and psoriatic arthritis.

  • Biologics are made from proteins
  • Biologics target the immune response leading to psoriasis
  • Biologic treatments are used for severe psoriasis
  • Patients can only enter the biologic program thru a specialist presciber

Biologics are drugs that target special immune system chemicals such as tumour necrosis factor (TNF) and interleukins. They are reserved for patients with the more severe forms of psoriasis and very strict criteria must be met to qualify for these high cost treatments. Only your dermatologist can prescribe these treatments for your psoriasis.

These new medications are not a cure for psoriasis. However, a large proportion of patients in whom they are used may be cleared, or almost cleared, of their psoriasis. At the present time in Australia these new ‘biologics’ include ‘Stelara’, ‘Enbrel’, ‘Humira’ and ‘Remicade’. All of these drugs are given at specific intervals by injection, either by the patient, or in a hospital by specially trained medical staff.

Because these drugs have been developed to affect only specific parts of your immune system, side effects are usually less common. However, side effects when they do occur may be more serious. Your dermatologist must ensure that you have not been exposed to certain infections such as tuberculosis and hepatitis before starting you on this medication.

New ‘biologics’, with even more specific immune effects and hopefully less side effects, are being developed. Your dermatologist will guide you in the most appropriate treatment.

Ustekinumab

Ustekinumab is a “biologic” designed to block interleukin-12 (IL-12) and interleukin-23 (IL-23), two special chemicals called cytokines, which in the skin lead to activation of special lymphocytes or white blood cells. This results in the formation of psoriasis plaques and inflammation. The drug is a special antibody against IL-12 and IL-23 in the blood stream and in psoriatic skin and is one of the newer classes of “biologics”.

Ustekinumab is usually administered by a needle into the skin. Most patients are able to do this themselves at home once their doctor or nurse has shown them the process. A special prefilled syringe containing a measured dose of ustekinumab is usually injected into the thigh or abdomen. Injections are usually required at the start, then at 4 weeks, then every 12 weeks. The dose of medication administered is determined by your doctor based on how much you weigh.

Ustekinumab has been developed to specifically target the parts of your immune system involved in psoriasis. However, other parts of the immune system may also be affected.

Ustekinumab may reduce your body’s ability to fight infections. Your doctor will test for certain infections that may become active while taking ustekinumab. In patients previously exposed to certain infections such as tuberculosis and hepatitis, these infections can become active again while taking ustekinumab. Other infections caused by bacteria, fungi and viruses can also occur. Some cancers such as breast, colon, kidney, prostate and thyroid cancers have been known to develop in patients treated with ustekinumab.

Some patients can have an allergic reaction to ustekinumab. Other potentially serious side effects with this medication include severe neurological disorders. Rarely, ustekinumab can cause severe skin reactions.

Reactions at the site of the injection can occur with ustekinumab including redness, bruising swelling, itch. These are usually relatively mild.

Other common side effects include headaches, tiredness and respiratory infections.

Before any patient is started treatment with ustekinumab, our doctors will require a chest x-ray to be performed as well as blood tests for hepatitis, HIV, tuberculosis, liver and kidney function and blood counts. In female patients, a pregnancy test may be required.

Your doctor will also ask you some important questions to try to identify any particular risk factors you may have when taking this medication.

All vaccinations should be up to date before starting this medication.

During treatment with ustekinumab, your doctor may ask you to have certain tests done. These usually involve regular blood tests to look for effects on your liver and blood counts as well as looking for markers of infection. If you develop particular symptoms during treatment with ustekinumab, certain other tests may be required.

Your doctor may also examine your skin for skin cancers periodically.

It is important that you report any symptoms or signs of illness or infection to your doctor when you are treatment with this medication.

There are no studies on the safety of ustekinumab in pregnancy. Its use should be reserved for those patients where the risk from their psoriasis outweighs the risk of the medication.

Infliximab

Infliximab is a "biologic" designed to block tumour necrosis factor (TNF) which in the skin leads to the formation of psoriasis plaques and inflammation. The drug binds directly to circulating TNF in the blood stream and in psoriatic skin thereby reducing the action of TNF in the development of psoriasis.

It is used in treating psoriasis, rheumatoid arthritis, psoriatic arthritis and inflammatory bowel disease. It has a rapid onset of action so it can be beneficial for unstable severe psoriasis or psoriasis requiring rapid control.

Infliximab is usually given to patients in a specialised treatment centre in a hospital or doctor’s clinic. It is given as an intravenous infusion straight into the blood stream every eight weeks. The infusion takes about 2 hours to complete. Patients are often monitored for side effects for a short while after the infusion is given and then are allowed to go home.

In some patients treated with infliximab, methotrexate may also be given to help maintain the effectiveness of the infliximab.

Infliximab has been developed to specifically target the parts of your immune system involved in psoriasis. However, other parts of the immune system may also be affected.

Infliximab may reduce your body’s ability to fight infections. Your doctor will test for certain infections that may become active while taking infliximab. In patients previously exposed to certain infections such as tuberculosis and hepatitis, these infections can become active again while taking infliximab. Other infections caused by bacteria, fungi and viruses can also occur. Some cancers such as lymphoma have been known to develop in patients treated with infliximab.

Some patients can have an allergic reaction to infliximab. Other potentially serious side effects with this medication include, effects on the liver, heart failure, blood problems, skin cancers and disorders of the nervous system. Rarely, infliximab can cause a worsening of psoriasis.

Before any patient is started treatment with infliximab, our doctors will require a chest x-ray to be performed as well as blood tests for hepatitis, HIV, tuberculosis, liver and kidney function and blood counts. In female patients, a pregnancy test may be required.

Your doctor will also ask you some important questions to try to identify any particular risk factors you may have when taking this medication.

All vaccinations should be up to date before starting this medication.

Your doctor may also examine your skin for skin cancers periodically.

It is important that you report any symptoms or signs of illness or infection to your doctor when you are treatment with this medication.

Infliximab can be used in pregnancy with caution. Studies are limited but seem to indicate that infliximab is non-teratogenic and safe. Its use is usually reserved for those patients where the risk from their psoriasis outweighs the risk of the medication.

Etanercept

Etanercept is a “biologic” designed to block tumour necrosis factor (TNF), which in the skin leads to the formation of psoriasis plaques and inflammation. The drug binds directly to circulating TNF in the blood stream and in psoriatic skin thereby reducing the action of TNF in the development of psoriasis.

It is used in treating psoriasis, rheumatoid arthritis, psoriatic arthritis and juvenile rheumatoid arthritis. Its onset of action is slower than infliximab so it can be useful for more stable severe psoriasis or psoriasis not requiring rapid control.

Etanercept is usually administered by a needle into the skin. Most patients are able to do this themselves at home once their doctor or nurse has shown them the process. A special prefilled syringe containing a measured dose of etanercept is usually injected into the thigh or abdomen. Injections are usually required once or twice a week as determined by your doctor.

In some patients treated with etanercept, methotrexate may also be given to help maintain the effectiveness of the etanercept.

Etanercept has been developed to specifically target the parts of your immune system involved in psoriasis. However, other parts of the immune system may also be affected.

Etanercept may reduce your body’s ability to fight infections. Your doctor will test for certain infections that may become active while taking etanercept. In patients previously exposed to certain infections such as tuberculosis and hepatitis, these infections can become active again while taking etanercept. Other infections caused by bacteria, fungi and viruses can also occur. Some cancers such as lymphoma have been known to develop in patients treated with etanercept.

Some patients can have an allergic reaction to etanercept. Other potentially serious side effects with this medication include, effects on the liver, heart failure, blood problems, skin cancers and disorders of the nervous system. Rarely, etanercept can cause severe skin reactions.

The most common side effect with etanercept is redness, swelling, bruising, itch or tenderness around the site of the injection into the skin. It is usually relatively mild.

Before any patient is started treatment with etanercept, our doctors will require a chest x-ray to be performed as well as blood tests for hepatitis, HIV, tuberculosis, liver and kidney function and blood counts. In female patients, a pregnancy test may be required.

Your doctor will also ask you some important questions to try to identify any particular risk factors you may have when taking this medication.

All vaccinations should be up to date before starting this medication.

Your doctor may also examine your skin for skin cancers periodically.

It is important that you report any symptoms or signs of illness or infection to your doctor when you are treatment with this medication.

Etanercept can be used in pregnancy with caution under certain circumstances. Studies are limited but seem to indicate that etanercept is non-teratogenic and safe. Its use is usually reserved for those patients where the risk from their psoriasis outweighs the risk of the medication.

Adalimumab

Adalimumab is a "biologic" designed to block tumour necrosis factor (TNF), which in the skin leads to the formation of psoriasis plaques and inflammation. The drug is a special antibody against TNF in the blood stream and in psoriatic skin thereby preventing the action of TNF in the development of psoriasis.

It is used in treating psoriasis, rheumatoid arthritis, psoriatic arthritis and inflammatory bowel disease. It is useful for more stable severe psoriasis or psoriasis not requiring rapid control.

Adalimumab is usually administered by a needle into the skin. Most patients are able to do this themselves at home once their doctor or nurse has shown them the process. A special prefilled syringe containing a measured dose of adalimumab is usually injected into the thigh or abdomen. Injections are usually required every two weeks.

Adalimumab has been developed to specifically target the parts of your immune system involved in psoriasis. However, other parts of the immune system may also be affected.

Adalimumab may reduce your body’s ability to fight infections. Your doctor will test for certain infections that may become active while taking adalimumab. In patients previously exposed to certain infections such as tuberculosis and hepatitis, these infections can become active again while taking adalimumab. Other infections caused by bacteria, fungi and viruses can also occur. Some cancers such as lymphoma have been known to develop in patients treated with adalimumab.

Some patients can have an allergic reaction to adalimumab. Other potentially serious side effects with this medication include, effects on the liver, heart failure, blood problems, skin cancers and disorders of the nervous system. Rarely, adalimumab can cause severe skin reactions.

The most common side effect with adalimumab is redness, bruising, swelling, itch or tenderness around the site of the injection into the skin. It is usually relatively mild.

Before any patient is started treatment with adalimumab, our doctors will require a chest x-ray to be performed as well as blood tests for hepatitis, HIV, tuberculosis, liver and kidney function and blood counts. In female patients, a pregnancy test may be required.

Your doctor will also ask you some important questions to try to identify any particular risk factors you may have when taking this medication.

All vaccinations should be up to date before starting this medication.

During treatment with adalimumab, your doctor may ask you to have certain tests done. These usually involve regular blood tests to look for effects on your liver and blood counts as well as looking for markers of infection. If you develop particular symptoms during treatment with adalimumab, certain other tests may be required.

Your doctor may also examine your skin for skin cancers periodically.

Adalimumab can be used in pregnancy with caution under certain circumstances. Studies are limited but seem to indicate that adalimumab is non-teratogenic and safe. Its use is usually reserved for those patients where the risk from their psoriasis outweighs the risk of the medication.

More info

Certain criteria will need to be met before patients can undertake Biologic treatments. This includes failure to respond to certain medications, and the severity of your psoriasis. The specialists at The Psoriasis Institute can advise you of the state of your psoriasis and keep track of your progress thru a process called a PASI score.

Brisbane’s Psoriasis Institute is the leading institution for the management of psoriasis, delivering a multitude of treatments for mild, moderate or severe psoriasis. We combine dietary, topical and state of the art phototherapy systems to treat YOUR psoriasis. Individualizing treatments is vitally important to achieve the best outcome for patients.

Biologic treatment of psoriasis is a new and exciting field of dermatology that has progressed rapidly over the last decade. Biologics are in fact protein molecules designed to target specific causes of psoriasis. These molecules target the T-cells which are the mediators of inflammation either directly or indirectly. They remain as the last line treatment of severe psoriasis that fails to respond to other treatments.

- Dr Scott Webber -  Consultant Dermatologist

PATIENT TESTIMONIAL

  • I can get an extra dose of phototherapy on Saturdays at the Institute, this really helps as I am at work during the week.
    - Mitch D. Sherwood
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