Biologics: What Are They and What Can They Do for Me?

Imagine you have had skin disease for months or years, and all the topical creams, steroids, and pills you’ve tried haven’t worked. Maybe you’ve done some research into the next step: a “biologic” medication, and you’re left with questions: what is a biologic, how do they work, and perhaps most importantly—will they work for me? This blog hopes to touch upon those questions.

What are biologics?

Put simply, biologics, according to the FDA, are large biological molecules derived from natural sources, such as human or animal cells, that are used to treat a variety of diseases. Biologics have become more and more popular in recent years, with well over $100B in annual sales in the United States. They are used to treat severe dermatologic, rheumatologic, and even gastrointestinal diseases.

In dermatology, biologics are FDA approved for a variety of conditions, such as eczema, psoriasis, psoriatic arthritis, and are prescribed often for severe disease or after other medications have been tried and failed. Biologics target the molecules and proteins specifically involved in the disease being treated.

Choosing a biologic

Let’s walk through a typical patient visit: someone with eczema visits their doctor. They’ve struggled with itchy skin for years, and steroid creams and other topicals haven’t helped. Enter the dermatologist! They will probably explain that a certain cytokine (a type of protein) has been found to mediate a lot of the inflammatory response that causes inflammation and itch. Now, enter dupilumab! Dupilumab is FDA approved for atopic dermatitis, and for good reason—it is a biologic that specifically targets one of the major pathways contributing to the disease. There are some side effects—including cold sores, and red or inflamed eyes, among others. Dupilumab is an injection, so a reaction including pain or swelling can occur at the injected site. If you are OK with these side effects, then your dermatologist will show you how to inject dupilumab yourself, make sure your insurance covers the medication, and send you on your way.

For treating eczema, the options for biologics are limited (making the choice easier!), but this is not the case for psoriasis; More than five biologics are currently FDA approved and more are going through the clinical trial pipeline. Before prescribing, your dermatologist will consider a variety of factors, including the biologic’s known side effects, your past medical history, affordability, biologics you’ve previously tried, and more.

What’s on the horizon

The COVID-19 pandemic has raised the question: If a lot of these biologics technically make me immunosuppressed, should I still try to get on a biologic? Since we don’t currently have enough evidence, the American Academy of Dermatology (AAD), the United States’ leading organization for dermatologists, recommends physicians use their clinical judgment. If you are concerned about using a biologic to treat your skin condition during the pandemic, then be sure to bring these concerns up to your dermatologist.

Otherwise, with biologics comprising one of the more newer and innovative classes of dermatologic medications, lots of exciting news is on the way. Clinical trials are being run for a variety of new drugs for different diseases. Biosimilars, which are essentially biologics but with no clinically meaningful differences, may soon enter the market, competing with and driving down the cost of expensive biologics.

There you have it! Biologics are a relatively new, exciting drug class, and for those patients benefitting from them, represent a plethora of new treatment options.