Biologic Therapies for Psoriasis: What You Need to Know

Biologics for psoriasis are injectable or infused medications that target specific proteins in the immune system responsible for the inflammation driving psoriasis. Unlike older body-wide treatments that suppress broad immune function, biologics block single molecules like TNF-alpha, IL-17, or IL-23. They are among the most effective psoriasis treatments available, with some helping 80% to 90% of people achieve clear or nearly clear skin.

If your psoriasis hasn’t responded to creams or drugs like methotrexate (see our treatments overview), your skin doctor has likely brought up biologics. These drugs have changed what’s possible for people with moderate to severe psoriasis. But with more than a dozen choices on the market, sorting out the differences can feel like a lot. This guide walks you through each class of biologics, the evidence behind them, and what to think about when picking one.

How Do Biologics Work for Psoriasis?

Biologics block specific immune proteins that drive the excess inflammation behind psoriasis. In psoriasis, the immune system attacks healthy skin cells by mistake. This triggers rapid cell turnover that creates thick, scaly plaques. Biologics stop this process at exact points in the inflammation chain rather than suppressing the whole immune system.

Psoriasis is an immune-mediated condition. Your immune system makes proteins called cytokines that tell skin cells to grow too fast. In healthy skin, cells replace themselves about every 28 to 30 days. In psoriatic skin, that cycle shrinks to just 3 to 4 days. The result is the red, raised, scaly patches called plaques.

Different biologics target different proteins in this chain. The three main targets are:

• TNF-alpha (tumor necrosis factor-alpha): An inflammatory protein active early in the immune response. TNF inhibitors were the first biologics approved for psoriasis.
• IL-17 (interleukin-17): A cytokine produced by T-cells that directly triggers the rapid skin cell growth seen in psoriasis.
• IL-23 (interleukin-23): A cytokine that activates the T-cells producing IL-17. Blocking IL-23 shuts down the inflammatory process further upstream.

Because biologics target specific proteins, they tend to cause fewer side effects than older drugs. Those drugs suppress the immune system more broadly. If you’re new to the condition, our guide on what psoriasis is covers the basics of how the immune system drives the disease.

What Are TNF Inhibitors?

TNF inhibitors were the first class of biologics approved for psoriasis. They block tumor necrosis factor-alpha, a protein that causes inflammation in the body. Options include adalimumab (Humira and biosimilars), etanercept (Enbrel), infliximab (Remicade and biosimilars), and certolizumab pegol (Cimzia). They are effective for many people, though newer biologic classes now show higher skin clearance rates.

TNF inhibitors have been used for psoriasis since the early 2000s. They have the longest safety record of any biologic class.

Adalimumab (Humira and biosimilars) is given as a self-injection every other week. In trials, about 71% of people with moderate to severe psoriasis reached PASI 75 (75% skin clearance) by week 16. Biosimilars like Hadlima, Hyrimoz, and Cyltezo now sell at lower cost.

Etanercept (Enbrel) is a self-injection given once or twice weekly. PASI 75 rates in trials reached about 49% at 12 weeks. That makes it less effective for clearing skin than some other biologics. It is still a good option for people who also have psoriatic arthritis.

Infliximab (Remicade and biosimilars) is given by IV infusion at weeks 0, 2, and 6, then every 8 weeks. It works the fastest of the TNF inhibitors, with PASI 75 rates near 80% at week 10. Biosimilars like Inflectra and Renflexis have broadened access.

Certolizumab pegol (Cimzia) is a self-injection given every other week after a loading phase. It’s the only biologic shown not to cross the placenta. This makes it an option for people who are pregnant or plan to be. PASI 75 rates reach about 76% at week 16.

Common TNF inhibitor side effects are injection site pain, colds, and headache. Long-term use requires watching for serious infections. Your doctor will test for tuberculosis (TB) before you start.

What Are IL-17 Inhibitors?

IL-17 inhibitors block interleukin-17, a protein directly behind the rapid skin cell growth in psoriasis. This class includes secukinumab (Cosentyx), ixekizumab (Taltz), brodalumab (Siliq), and bimekizumab (Bimzelx). IL-17 inhibitors tend to clear skin faster and better than TNF inhibitors. Many people reach PASI 90 or even PASI 100 (full clearance).

IL-17 is one of the last signals in the inflammation chain that tells skin cells to multiply fast. Blocking it produces some of the highest clearance rates in psoriasis treatment.

Secukinumab (Cosentyx) is a self-injection given weekly for the first 5 weeks, then monthly. In the ERASURE trial, 81.6% of participants achieved PASI 75 and 59% achieved PASI 90 by week 12. It is also approved for psoriatic arthritis and ankylosing spondylitis.

Ixekizumab (Taltz) is a self-injection given every 2 weeks for 12 weeks, then monthly. PASI 75 rates in the UNCOVER trials reached about 90% at week 12, with roughly 70% of people achieving PASI 90. Ixekizumab beat etanercept by a clear margin in head-to-head trials.

Brodalumab (Siliq) differs from other IL-17 drugs. It blocks the IL-17 receptor rather than the protein itself. This means it blocks multiple forms of IL-17. It’s a self-injection given every 2 weeks after a loading phase. PASI 75 rates reached about 83% at week 12 in the AMAGINE trials. Brodalumab has a boxed warning about suicidal thoughts and behavior. It is only sold through a restricted program called SILIQ REMS.

Bimekizumab (Bimzelx) is the newest IL-17 inhibitor. The FDA approved it in October 2023. It blocks both IL-17A and IL-17F, two related cytokines. In the BE VIVID trial, 85% reached PASI 90 at week 16 and 59% reached full clearance (PASI 100). It is given as a self-injection every 4 weeks after a loading phase. Oral thrush occurred more often with bimekizumab than with other IL-17 drugs. It affected about 7% to 16% of trial patients.

People on IL-17 inhibitors should know these drugs may worsen inflammatory bowel disease (IBD). If you have Crohn’s disease or ulcerative colitis, your skin doctor will likely pick a different biologic class. For the latest pipeline drugs in this class, see our article on new and emerging psoriasis treatments.

What Are IL-23 Inhibitors?

IL-23 inhibitors block interleukin-23, a protein that turns on the T-cells behind psoriasis inflammation. This class includes risankizumab (Skyrizi), guselkumab (Tremfya), and tildrakizumab (Ilumya). IL-23 inhibitors offer high clearance rates with fewer doses. Many people keep their results with shots only every 8 to 12 weeks after the loading phase.

By targeting IL-23, these biologics step in earlier in the inflammation chain. Blocking IL-23 lowers the production of IL-17 and other downstream proteins. It does this without removing IL-17, which the body still needs for some immune defenses. This early-in-the-chain approach may explain why IL-23 inhibitors have strong safety records.

Risankizumab (Skyrizi) is given as two injections at the start, again at week 4, and then every 12 weeks. In the UltIMMa-1 trial, 75% of participants achieved PASI 90 at week 16, and 36% achieved PASI 100. At one year, clearance rates kept rising, with PASI 90 rates hitting about 82%. Risankizumab is also approved for psoriatic arthritis and Crohn’s disease.

Guselkumab (Tremfya) is a self-injection given at weeks 0 and 4, then every 8 weeks. In the VOYAGE 1 trial, 73.3% of participants achieved PASI 90 at week 16. It was the first IL-23 inhibitor approved for psoriasis. Tremfya is also approved for psoriatic arthritis.

Tildrakizumab (Ilumya) is given at weeks 0 and 4, then every 12 weeks. PASI 75 rates reached about 64% at week 12 in the reSURFACE trials. Its clearance rates are lower than risankizumab or guselkumab. But its dosing schedule and safety record make it a good option for some.

IL-23 inhibitors tend to have the best safety records of all biologics for psoriasis. Side effects are usually mild. They include colds, injection site reactions, and headache. Serious infection rates in trials were similar to those seen with placebo.

What About Ustekinumab (Stelara)?

Ustekinumab (Stelara) blocks both IL-12 and IL-23, two related cytokines. It was one of the first biologics to target the IL-23 pathway and has been used for psoriasis since 2009. PASI 75 rates reach about 67% to 76% at week 12. Biosimilar versions are now becoming available, which may reduce costs.

Stelara is given by injection at weeks 0 and 4, then every 12 weeks. Dosing is weight-based: 45 mg for people weighing 100 kg (220 lbs) or less, and 90 mg for those over 100 kg.

For over a decade, Stelara was the top choice for long-interval treatment. Head-to-head trials have since shown that newer IL-23 inhibitors like risankizumab and guselkumab clear skin better. The IXORA-S trial found ixekizumab superior to ustekinumab as well. Still, Stelara has a long safety record. Many people doing well on it have no medical reason to switch.

The first biosimilar for Stelara, ABP 654 (Pyzchiva), was FDA-approved in 2025. More biosimilars are expected to follow, which should lower the cost.

How Do Biologics Compare in Effectiveness?

Among biologics for psoriasis, IL-17 and IL-23 drugs tend to produce the highest clearance rates. TNF inhibitors come next. In head-to-head trials, bimekizumab, risankizumab, and ixekizumab rank among the top drugs. The best biologic for you depends on your health, other conditions, how often you want shots, and insurance.

Doctors measure biologic results using the PASI score, which rates psoriasis on a scale of 0 to 72. Results are reported as PASI 75 (75% better), PASI 90 (90% better), or PASI 100 (full clearance).

Here is how the classes compare based on published clinical trial data:

PASI 90 rates at week 12 to 16 (approximate):

• Bimekizumab (Bimzelx): 85%
• Ixekizumab (Taltz): 70%
• Risankizumab (Skyrizi): 75%
• Secukinumab (Cosentyx): 59%
• Guselkumab (Tremfya): 73%
• Infliximab (Remicade): 57%
• Adalimumab (Humira): 40%
• Ustekinumab (Stelara): 42% to 51%
• Etanercept (Enbrel): 21%

These numbers come from separate trials with different patients, so direct comparison has limits. Head-to-head studies give stronger evidence. A 2023 review in The Lancet found that bimekizumab, ixekizumab, and risankizumab ranked highest for short-term skin clearance.

Your skin doctor will weigh clearance rates against other factors. These include psoriatic arthritis (some biologics treat both), infection history, conditions like IBD, and how often you want shots.

What Side Effects Should You Watch For?

All biologics carry some infection risk because they dial down parts of the immune system. Common side effects are injection site reactions, colds, and headache. TNF inhibitors may raise the risk of serious infections and TB coming back. IL-17 inhibitors can cause oral thrush and may worsen IBD (inflammatory bowel disease). IL-23 inhibitors generally have the mildest side effect profiles.

All biologics suppress part of the immune system, so they carry some infection risk. The specific risks vary by drug class.

Across all biologics:

• Injection site reactions (redness, swelling, itching)
• Upper respiratory infections
• Headache

TNF inhibitors specifically:

• Higher risk of serious infections, including TB reactivation
• Rare cases of heart failure worsening
• Small increased risk of certain cancers with long-term use (though large registry studies have not confirmed a significant increase)

IL-17 inhibitors specifically:

• Oral candidiasis (thrush), especially with bimekizumab
• Potential worsening of inflammatory bowel disease
• Neutropenia (low white blood cell counts) in rare cases

IL-23 inhibitors specifically:

• Generally the fewest reported side effects
• Mild upper respiratory symptoms
• Injection site reactions

Before starting any biologic, your doctor will order lab work. This includes a TB test, hepatitis B and C screening, and a blood count. Regular testing continues while you’re on treatment.

What Do Biologics Cost, and How Can You Afford Them?

Biologic medications for psoriasis have list prices ranging from $30,000 to $80,000 per year, but most people pay significantly less through insurance, manufacturer copay programs (which can reduce costs to $0 to $5 per dose), and patient assistance programs. Biosimilars for adalimumab, infliximab, and ustekinumab have started to cut prices.

Biologic list prices are high. They often range from $30,000 to $80,000 per year without insurance. What you pay depends on your insurance, the drug, and whether the maker offers help programs.

Biosimilars have started to lower costs. Biosimilars for adalimumab (Humira) hit the U.S. market in 2023. Biosimilars for infliximab and ustekinumab are available or in the works. Biosimilars usually cost 15% to 40% less than the original brand.

Manufacturer copay programs can reduce your out-of-pocket costs to as little as $0 to $5 per dose if you have commercial insurance. Most makers offer these programs. They include AbbVie (Skyrizi, Humira), Novartis (Cosentyx), Eli Lilly (Taltz), and Janssen (Tremfya, Stelara).

Patient assistance programs exist for people who are uninsured or underinsured. The National Psoriasis Foundation maintains a list of these programs at psoriasis.org.

Insurance navigation tips:

• Ask your dermatologist’s office for help with prior authorization paperwork
• If your insurance denies a biologic, request a peer-to-peer review where your doctor speaks directly with the insurance company’s medical reviewer
• Check whether your plan requires you to try (and fail) cheaper treatments first, a process called step therapy
• Appeal denials in writing, including clinical documentation of your disease severity and prior treatment failures

Can You Switch Between Biologics?

Yes, switching biologics is common and often effective. About 30% to 40% of people on a biologic will need to switch at some point. Reasons include loss of response, side effects, or other factors. Studies show most people respond well to a second biologic, even in the same drug class. Switching to a different type of drug often gives the best results.

Loss of response happens when your body makes antibodies against the biologic. This lowers its effect over time. This is called immunogenicity.

When switching, your skin doctor may suggest a different drug class. For example, if a TNF inhibitor stops working, an IL-17 or IL-23 inhibitor often works well. A 2022 study in JAAD found that switching from TNF to IL-23 led to PASI 90 in about 60% by week 16.

Your doctor will help time the switch to keep gaps short and lower flare risk during the change. For tips on managing daily life while adjusting treatments, see our guide to living well with psoriasis.

Frequently Asked Questions

How long do biologics take to work for psoriasis?

Most people see noticeable improvement within 2 to 4 weeks, with full results by 12 to 16 weeks. Some biologics, like infliximab, work faster because they are given by IV infusion. IL-17 inhibitors also tend to show rapid early improvement.

Are biologics a cure for psoriasis?

No. Biologics control psoriasis but do not cure it. If you stop taking a biologic, psoriasis symptoms typically return within a few weeks to months. Some people maintain partial remission for longer, but most need ongoing treatment.

Can you take biologics while pregnant?

This is a conversation for your doctor, as the answer depends on the specific biologic. Certolizumab pegol (Cimzia) has the most pregnancy safety data because it does not cross the placenta. Current guidelines from the National Psoriasis Foundation suggest that some biologics may be continued during pregnancy with medical supervision.

Do biologics weaken your immune system?

Biologics suppress specific parts of the immune system, not all of it. Your ability to fight most infections remains intact. Still, you should stay up to date on vaccinations (live vaccines are generally not recommended during treatment) and report any signs of infection to your doctor promptly.

Can you drink alcohol while on a biologic?

Moderate alcohol use is generally considered acceptable with most biologics. Unlike methotrexate, biologics are not processed by the liver in a way that alcohol directly worsens. That said, heavy drinking can worsen psoriasis itself and may reduce how well treatment works.

How often do you need injections with biologics?

Dosing frequency varies widely. Some biologics require weekly injections during a loading phase, while others are given every 8 to 12 weeks for maintenance. IL-23 inhibitors like risankizumab and tildrakizumab have the longest intervals at every 12 weeks.

What happens if your insurance denies a biologic?

You have the right to appeal. Ask your dermatologist to submit a letter of medical necessity with documentation of your disease severity, prior treatments that failed, and the clinical rationale for the requested biologic. Many denials are overturned on appeal. Manufacturer patient support programs can also help you through the process.

Are biosimilars as effective as the original biologic?

Yes. The FDA requires biosimilars to demonstrate no clinically meaningful differences in safety, purity, or potency compared to the original biologic. They undergo rigorous testing and are a reliable, lower-cost alternative.

Sources and References

1. National Psoriasis Foundation. “Biologics.” psoriasis.org/biologics
2. Menter A, et al. “Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics.” Journal of the American Academy of Dermatology, 2019;80(4):1029-1072.
3. Gordon KB, et al. “Efficacy and safety of risankizumab in moderate-to-severe plaque psoriasis (UltIMMa-1 and UltIMMa-2).” The Lancet, 2018;392(10148):650-661.
4. Griffiths CEM, et al. “Comparison of ixekizumab with etanercept or placebo in moderate-to-severe psoriasis (UNCOVER-2 and UNCOVER-3).” The Lancet, 2015;386(9993):541-551.
5. Reich K, et al. “Bimekizumab versus secukinumab in plaque psoriasis (BE RADIANT).” New England Journal of Medicine, 2021;385(2):142-152.
6. Langley RG, et al. “Secukinumab in plaque psoriasis: results of two Phase 3 trials (ERASURE and FIXTURE).” New England Journal of Medicine, 2014;371(4):326-338.
7. Blauvelt A, et al. “Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis (VOYAGE 1).” Journal of the American Academy of Dermatology, 2017;76(3):405-417.
8. Armstrong AW, et al. “Comparison of biologics and oral treatments for plaque psoriasis: a meta-analysis.” JAMA Dermatology, 2020;156(3):258-269.
9. Sbidian E, et al. “Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis.” Cochrane Database of Systematic Reviews, 2023.
10. U.S. Food and Drug Administration. “Biosimilar Product Information.” fda.gov/drugs/biosimilars
11. Reich K, et al. “Certolizumab pegol in moderate-to-severe chronic plaque psoriasis (CIMPASI-1 and CIMPASI-2).” Journal of the American Academy of Dermatology, 2019;81(3):737-746.
12. Gottlieb AB, et al. “Ustekinumab, a human interleukin 12/23 monoclonal antibody, for psoriatic arthritis.” Annals of the Rheumatic Diseases, 2009;68(6):896-901.
13. National Psoriasis Foundation. “Insurance and Financial Assistance.” psoriasis.org/insurance
14. Lebwohl MG, et al. “Switching biologic therapies in dermatology.” Journal of the American Academy of Dermatology, 2022;87(5):1098-1109.
15. Mahil SK, et al. “Psoriasis treat to target: defining outcomes in psoriasis using data from a real-world, population-based cohort study.” The Lancet, 2022;400(10359):1281-1291.

Psoriasis Daily is strictly a news and information website about psoriasis. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.