Biologics for psoriasis

New therapies for the skin: Biologics block messenger substances and allow severe psoriasis to heal quickly, where conventional treatments have often failed

Itching and burning: Elbows and knees are most commonly affected in psoriasis

© Getty Images / 4x6

Those who have it feel uncomfortable and suffer from the looks of others: psoriasis gets under the skin. About two million people in Germany are affected by the chronic inflammatory disease.

Your skin cells renew themselves up to four times faster than in healthy people. The result: thick red spots with whitish scales, usually on the elbows, knees, behind the ear or in the anal fold, which often itch or burn.

A great deal of suffering for those affected

Psoriasis is not contagious, but the predisposition for it can be inherited. In response to a trigger - stress, infections or mechanical stimuli - the immune system then mistakenly attacks the body's own cells.

Chronic inflammation can also affect blood vessels and organs, and it also increases the risk of type 2 diabetes, cardiovascular disease or depression. Some of those affected develop painful inflammation of the joints, the so-called psoriatic arthritis.

The suffering is great - especially in people with moderate to severe psoriasis: More than a tenth of their skin is covered with scaly patches, and particularly sensitive and highly stressed body regions such as hands or feet are often involved.

Revolution in psoriasis therapy

57 percent of the total of 400,000 people affected in Germany never have symptom-free skin because conventional therapies fail: skin ointments and creams based on urea, salicylic acid or cortisone have just as little effect on them as light therapy or drugs that suppress the immune system.

For some years now, drugs with a new mode of action, so-called biologics, have been on the market. You revolutionized psoriasis therapy. "Biologics intervene in the body's defective defense reaction: They inhibit the messenger substances that trigger psoriasis and accompanying diseases and stop the inflammation on site," explains Professor Knut Schäkel.

Professor Knut Schäkel heads the interdisciplinary center for chronic inflammatory diseases at Heidelberg University Hospital

© W & B / Andreas Henn

Biologics suppress messenger substances

The dermatologist heads the interdisciplinary center for chronic inflammatory diseases at Heidelberg University Hospital. For more than ten years, he has been successfully treating people with psoriasis, in whom the previously common medications have failed: "Thanks to biologics, most people achieve symptom-free or almost symptom-free skin within a few weeks."

With the help of a pen, patients inject the preparations themselves directly under the skin, similar to how diabetics inject their insulin. These drugs do not suppress the entire immune system, but only block the inflammatory messengers that cause psoriasis: TNF alpha, interleukin-23 or interleukin-17.

Promising drug

The still young interleukin-23 and -17 blockers are particularly effective: "The number of patients in whom psoriasis improves by 90 to 100 percent is significantly higher than with older biologics. This means symptom-free for many severely affected people Skin, "says Knut Schäkel happily.

Biologics are not only effective, but also safe, studies confirm. TNF-alpha blockers increase the risk of respiratory infections, and interleukin-17 inhibitors favor mild to moderate yeast infections. However, the fear that the drugs could also increase the risk of cancer contradict scientists who evaluated four studies in 2018.

Cheaper tablets at the start

Doctors are now allowed to prescribe some biologics immediately and without restrictions to treat moderate to severe psoriasis. However, the drugs are rarely prescribed. The reasons are mostly economic: biologics are expensive. Up to 20,000 euros can be incurred per patient and year. For comparison: the costs of conventional therapies range between 1,000 and 5,000 euros.

New drugs could solve the dilemma in the near future: So-called small molecules, active ingredients with a small molecular mass, are cheaper than biologics, are usually well tolerated and available as tablets. The first representative, Apremilast, is already on the market. Approved for psoriasis and psoriatic arthritis, the drug stops inflammation on the skin, joints, spine and internal organs.