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Biologic therapy

What are biologics?

Biological therapies are prescribed predominantly for those people with moderate to severe psoriasis who have failed to respond to other treatments, or  are unable to take other medications for their skin. They target a part of the immune response that is problematic, and are either monoclonal antibodies or fusion proteins. These drugs are very specific and are expensive to produce, and their use is therefore governed by NICE (the National Institute for Clinical Excellence) ensuring that they are available to those patients who need them the most. Patients being considered for a biological therapy will be assessed by the specialist nurse, according to NICE guidelines. 

All biologic medication is given by injection, either in the home (etanercept / Enbrel, adalimumab / Humira and ustekinumab / Stelara) or as an intravenous infusion in the Dermatology Centre (infliximab / Remacaide). The choice of drug will depend upon the severity of the condition, any contra-indications and personal preferences. Prescriptions for home injections are managed either by Healthcare at Home or Careology, who deliver the drugs to the patient's home and send a nurse out to teach self-injection (or, in the case of Stelara, to perform the injections). 

Many patients who start a biological therapy will already have tried such drugs as methotrexate, ciclosporin or acitretin, and may have experienced significant side effects. Whilst biological therapies tend not to cause common side effects to the same extent, they do dampen the body's ability to fight infection, sometimes significantly. For this reason a full screening process, that looks at general health as well as the presence of latent infections including tuberculosis, is performed. Patients are advised to take sensible measures to protect themselves from infection, including having the annual flu vaccination, the pneumococcal vaccination, and avoiding high risk foods such as raw egg. They should alert their GP if they feel unwell, and a nurse support line is available if they have questions regarding ongoing treatment. A full list of possible side effects is available when a patient is being considered for a biologic. Patients are reviewed every six months, by either the consultant or the specialist nurse; more often at the start of treatment, when it is important to check that they are on a drug that is effective for them. Blood tests checking the health of the kidneys, liver and the full blood count should be performed six monthly. 

Generally patients may stay on a biological therapy for many years, sometimes with short breaks in treatment depending on the drug and individual circumstances. As time goes on the treatment may become less effective, and it may be necessary to add in other treatment or switch biological drug. 

As these are new drugs it is not yet possible to say what the long-term effects are. For this reason we are part of a national study, the British Association of Dermatologists Biologic Interventions Register (BADBIR).  All psoriasis patients new to biologics, or who are switching therapy, will be asked to take part.

Details of this study are on the BADBIR website.

Visit this website to find out more on biologics.