How do biologics work?

Biologics are a new type of psoriasis medication made from proteins produced by living human and animal cells. Biologics work by targeting the underlying cause of psoriasis. They act on specific areas of the immune system that are overactive in people who have psoriasis. Some biologics work by stopping T cells, a major contributing factor in psoriasis, from becoming activated and/or from migrating to the skin, or by reducing the number of activated T cells. Biologics can also work by blocking immune system messengers that play a role in the overproduction of skin cells.

What makes biologics different from other psoriasis treatments? Most oral psoriasis drugs work by decreasing the activity of the immune system in general. This is called immunosuppression, and can lead to an increased risk of infection, liver damage, or kidney damage. Biologics are different because they only work on those parts of the immune system that are overactive. This means they may have a lower risk of infections and side effects in other organs when compared with immunosuppressants.

There is another important difference between biologics and other psoriasis treatments. With biologics that inhibit T cells that cause psoriasis, treatment effects can last even after the drug is stopped. Relief of symptoms that continues after the drug is stopped is called a "remission." It means that people with psoriasis may take a break from drug treatment - this is called a "drug holiday." With other types of psoriasis drugs, the symptoms can return once the drug is stopped. When a drug is used continuously to keep symptoms at bay, this is known as "suppression."

Alefacept is the first biologic available in Canada for the treatment of psoriasis. It is used in people with moderate to severe chronic plaque psoriasis who are candidates for phototherapy or systemic therapy. It is believed to work by preventing T cell activation and by decreasing the numbers of activated T cells. Alefacept is given by intramuscular (into a muscle) injection once weekly for 12 weeks, followed by a treatment-free period of at least 12 weeks. About 7 out of 10 people notice a meaningful improvement in symptoms after 2 courses of treatment. The improvement usually lasts for about 7-8 months after treatment is stopped, which means that long treatment-free periods are possible. For more information about biologics, contact your dermatologist.

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