Biologics are indicated for the treatment of psoriatic arthritis in combination with or without non-biologic DMARDs. Unlike small molecule drugs such as aspirin, biologics are made from cells or proteins and are much more complex. Biologics target and block the immune system cells responsible for inflammation in the body such as TNF (tumour necrosis factor), interleukin 17-A/F, or interleukins 12 and interleukin 23.
However, blocking these immune cells can also reduce the body’s ability to fight infection. Therefore, before starting biologic therapy, people usually have standard vaccinations for flu, COVID-19, hepatitis A and B, pneumonia, shingles, tetanus, diphtheria, and other infectious diseases. It is a good idea to review your vaccination history with your doctor before starting a biologic.
Before treatment begins, people generally have routine tests to screen for liver problems, hepatitis, and tuberculosis. If you have or develop a serious infection, your doctor might instruct you to stop your biologic therapy until you are better. Always talk with your healthcare provider before stopping your medication.
Dosage Form
Most biologics are given by subcutaneous injection or by intravenous (IV) infusion.
Subcutaneous injections can be administered by a nurse or by the patient themselves after proper training. Patients usually receive training when they first start a new biologic. It is a good idea to revisit your injection technique with your doctor or pharmacist occasionally to ensure you are administering your dose correctly.
Intravenous (IV) infusions are usually administered by a nurse in an infusion clinic. The patient support program associated with your medication will usually help to set up your first infusion at a clinic of your choice. You can discuss your options with your healthcare provider.
Biosimilars
A biosimilar (also referred to as a subsequent entry biologic) is a similar but not identical version of an existing reference biologic (also called an originator biologic). Biosimilars become available on the market once the patent for the reference drug has expired. The reference drug is the first drug of its kind to be developed and as such, the drug company that makes it gets to be the sole manufacturer of that drug for a certain length of time. Once that time is up, other manufacturers are permitted to create biosimilars. We say that biosimilars are similar to the originator but not exactly the same because it is impossible to make an identical copy of a biologic due to its intrinsic complexity. Additional testing and research are done on biosimilars to ensure that they have the same efficacy and safety as the originator version of the biologic.
Potential Side Effects
Potential side effects include injection site reactions such as pain, redness, swelling, itching, or bruising at the injection site. Since these drugs may reduce your ability to fight off infections, patients may be at a higher risk of developing upper respiratory infections (i.e., cold, flu), pneumonia, bronchopneumonia, bronchitis, and herpes zoster (shingles). Tell your doctor if you develop any signs of infection such as a fever or if you experience infections that are not getting better or that keep coming back. Your therapy will usually start after you have been tested for tuberculosis and hepatitis and you have received the recommended vaccines. If you are pregnant or planning to become pregnant, you can talk to your doctor about whether to continue or pause therapy.
Cost Considerations
Biologics are expensive. Public insurance, private insurance, and other coverage options may be available to help patients cover the cost of these therapies. Each biologic has an associated patient support program (PSP) that helps patients to navigate the healthcare system and identify what coverage is available to them.
TNF-Inhibitors work to reduce the signs and symptoms of psoriatic arthritis by blocking the action of tumour necrosis factor (TNF), a protein involved in inflammation. TNF-inhibitors can help to reduce the progression of joint damage and improve the appearance of psoriatic skin lesions.
TNF Inhibitors
Originator: Humira
Biosimilars: Abrilada, Amgevita, Hadlima, Hulio, Hyrimoz, Idacio, Simlandi, Yuflyma
Time Frame
Patients can start to see benefits after 2 to 3 weeks, but response is best determined after 3 to 4 months of therapy.
Dosage Form
Pre-filled syringes
Autoinjector
Dose and frequency
The usual dose is 40mg injected subcutaneously every 2 weeks.
Patient Support Program
Interleukin Inhibitors
Interleukin inhibitors can prevent specific proteins in the body—called interleukins—from causing the body’s immune system to attack the joints. The medicines work by neutralizing the activities of various interleukins which are present at increased levels in diseases such as psoriatic arthritis. By blocking this signal, these therapies stop the body from attacking itself and improve joint pain, swelling, and inflammation.
Potential Side Effects
Potential side effects include injection site reactions such as pain, redness, swelling, itching, or bruising at the injection site. Since interleukin inhibitors may reduce your ability to fight off infections, patients may be at a higher risk of developing upper respiratory infections (i.e., cold, flu), pneumonia, bronchopneumonia, bronchitis, and herpes zoster (shingles).
Tell your doctor if you develop any signs of infection such as a fever or if you experience infections that are not getting better or that keep coming back. Your therapy will usually start after you have been tested for tuberculosis and hepatitis and you have received the recommended vaccines. If you are pregnant or planning to become pregnant, you can talk to your doctor about whether to continue or pause therapy.
Interleukin Inhibitors
Brand Name: Taltz
What it does / How it works
Ixekizumab is an IL-17A inhibitor, a monoclonal antibody. This medicine neutralizes the activity of IL-17A, which is present at increased levels in diseases such as psoriatic arthritis.
Time frame
Patients can expect to see treatment benefits within 4-6 weeks of starting the medication.
Dosage Form
Pre-filled syringe
Autoinjector
Dose and frequency
An initial dose of 160mg is injected subcutaneously at week 0 followed by a maintenance dose of 80mg every 4 weeks.
Patient Support Program
Contact LillyPlus Patient Support Program by Eli Lilly at 1-877-219-8908 or email
CTLA-4 IG
Brand Name: Orencia
In psoriatic arthritis, inflammatory cells attack the body’s own healthy cells by mistake. Abatacept is a type of modified antibody called CTLA-4 Ig, that suppresses these inflammatory cells and stops them from attacking healthy cells. Abatacept can help to improve joint pain and swelling and reduce long-term damage to the joints.
Time frame
Patients may start to see treatment benefits in 3 to 6 months.
Dosage Form
IV infusion
Prefilled syringe
Autoinjector
Dose and frequency
Orencia is administered as a 30-minute IV infusion given at 0, 2 and 4 weeks then every 4 weeks thereafter.
Orencia can also be administered by subcutaneous injection. The usual dose is 125mg injected once a week.
Potential Side Effects
Since abatacept may reduce your ability to fight off infections, patients may be at a higher risk of developing upper respiratory infections (i.e., cold, flu), pneumonia, bronchopneumonia, bronchitis, and herpes zoster (shingles). Tell your doctor if you develop any signs of infection such as a fever or if you experience infections that are not getting better or that keep coming back. Your therapy will usually start after you have been tested for tuberculosis and hepatitis and you have received the recommended vaccines. If you are pregnant or planning to become pregnant, you can talk to your doctor about whether to continue or pause therapy.
Rarely, patients administering their medication by subcutaneous injection might experience injection site reactions such as pain, redness, swelling, itching, or bruising at the injection site.
Patients who receive an intravenous infusion may experience an infusion reaction such as itching, rash or hives, redness of the face and neck, or nausea. Your nurse will monitor you for these reactions during the infusion and can help you manage these symptoms if they occur.
Patient Support Program
Contact ORENCIA Response Program by Bristol Myers Squibb at 1-877-979-3200.
