Beyond Biologics for Psoriatic Arthritis

Patients need better, effective options.

Although biologics have advanced the treatment of psoriasis and psoriatic arthritis, this therapy class is not meeting the needs and preferences of all patients. According to a recent patient survey, nearly half of surveyed patients who have been prescribed biologic therapies found their treatment “burdensome.”

“The choices for biologics are fairly limited,” said Dr. Kimme Hyrich, a rheumatologist at the University of Manchester. “Because of the way the molecules work within the drug, it is actually not possible to take these drugs orally, so they have to be given by injection [at home] or by infusion at a hospital once a month.”

Nearly half of surveyed patients who have been prescribed biologic therapies found their treatment ‘burdensome.’

For some, these treatments can be painful and can lead to fear and anxiety over injections. “The first time I had to inject myself, I put the needle back in the refrigerator to think it over,” Howard Chang, a psoriasis patient being treated with a biologic, wrote on his blog. “I finally did gather enough courage to inject myself, wondering for days after if I had done it correctly. Putting a needle into my own leg or stomach felt like the most counter-intuitive action I could engage in.”

Aside from pain, there’s also inconvenience. Preparing for the injections takes time out of a patient’s day. Since biologics are relatively unstable, they must be stored in a refrigerator then warmed to room temperature just before use. And to reduce pain, doctors recommend that patients ice the injection area before treatment.

Fear, anxiety and physical preparation of these injections make biologics burdensome, according to 31 percent of the psoriasis and psoriatic arthritis patients surveyed. Another 20 percent of patients reported that biologics were just overall inconvenient. The burden and inconvenience of biologics together led some patients to discontinue treatment.

For younger patients, convenience and practicality might be especially important. Twenty-five young adults with arthritis said they prefer treatments that do not interfere with their normal day-to-day life, according to an ongoing study at Newcastle University.

Aside from convenience, younger patients below the age of 18 should also be aware that side effects of biologics in young adults are not well understood, according to Hyrich. “It’s important that these drugs be researched in that age group, because often these patients are omitted from clinical trials because they are not old enough,” Hyrich said.

Education may help patients better accommodate biologic treatments into their lives, according to Hyrich. Yet the ultimate goal is to have more convenient, effective options. “There is still a hunt for oral alternatives to biologics, including more targeted therapies,” she said.