Treating Psoriasis: Tips for Switching Biologics

Biologics are the heavy hitters for treating people with moderate to severe psoriasis who haven’t had good results with other medications. They target the specific parts of your overactive immune system that cause psoriasis, calming them down. That’s why biologics are so effective at clearing skin, reducing side effects and managing the condition, so it doesn’t get worse.

There are many biologics on the market designed to treat psoriasis, psoriatic arthritis, or both. Still, even if you find one that works well for you now, you may have to switch to another in the future for one reason or another, notes Marisa Garshick, MD, an assistant clinical professor of dermatology at Weill Cornell Medical Center and dermatologist at MDCS Dermatology in New York City.

In fact, research shows that changing biologics is common. After two years, 1 in 4 people with psoriasis change from one biologic to another. Doing so can help improve your quality of life. Here’s what to know if you have to make a switch.

Reasons for Changing From One Biologic to Another

All biologics work slightly differently, so finding one that’s right for you can take some trial and error. According to Dr. Garshick, some of the reasons you might need to switch biologics include:

• It’s not effective. If a particular biologic isn’t working well for you, it may be a sign to try another one. But, discuss your concerns with your doctor to make sure you’re not rushing a decision. “It can take several months to know if a biologic is working or not,” says Garshick. So, give your current medication a few months. If you haven’t seen enough improvement by then, ask for a change.
• It has side effects. Each biologic comes with potential side effects. Common ones include flu-like symptoms, a higher risk of infection, and a skin reaction if you inject the biologic, according to the American Academy of Dermatology (AAD). Most of these side effects are mild, though. Still, if you have concerns about the side effects or can’t tolerate them, that’s a valid reason to make a switch. People tend to change medications for safety reasons or because they don’t feel their biologic is working well, one study found.
• There’s a newer option. “In some cases, a biologic may be working, but now that there are many different biologics to choose from, it’s possible a different one may work even better,” says Garshick. According to research published in 2023, switching biologics is common, and doing so can help people with psoriasis achieve greater skin clarity and improved quality of life.
• Your health insurance changes. Biologics tend to be very expensive. If you change health insurance or your plan no longer covers a certain biologic, talk with your doctor to switch to one that is covered.

Making a Changeover Successfully

If you and your doctor have decided it’s time to try a new biologic, these 5 steps can help make the transition go as smoothly as possible:

1. Follow your dermatologist’s directions closely. In some cases, your doctor may recommend stopping the existing biologic for a certain amount of time — called a washout period — before starting a new one. That might require patience on your part if symptoms get worse. In other cases, your doctor may have you double up on the two medications during the transition period. It’s important to keep your dermatologist in the loop about how you’re feeling, so you can make the switch safely.
2. Make sure you take the new biologic exactly as directed. Different types of biologics require different schedules and may take getting used to, if you’re switching from one type to another. For example, some injectable biologics are taken once or twice a week, while infusions may start at every four to six weeks and then switch to every eight to 12 weeks. “The dosing for biologics is very intentional,” says Garshick. “It’s important to follow the scheduled dosing protocol to ensure optimal results,” she adds.
3. Understand when you may see results. “While some improvement may be noticed within two to four weeks for certain biologics, it can often take three to four months for the full benefits to kick in,” says Garshick. “Give the biologic enough time to take effect prior to discontinuing or switching.”
4. Get your flu shot. Because biologics affect your immune system, it’s important to get a yearly flu shot. Not only are you at greater risk of getting the flu, but if you do get it, you may have to go off your biologic until you’re better, according to the National Psoriasis Foundation.
5. Take care of your overall health. Following a healthy lifestyle — limiting alcohol, maintaining a healthy weight, not smoking — can also help make psoriasis treatment more effective, according to the AAD.

It can be frustrating to have to change from one treatment to another, but it’s worth it if your new medication gives you better control over your psoriasis. Just remember that everyone with psoriasis responds differently to medication. That’s why it’s important to partner with your doctor to create a treatment plan that’s right for you, even if it needs to change later.