Biologic treatments (biologics) are a relatively recent type of systemic treatment. They are injected into the body, either just under the skin (subcutaneous) or as an intravenous infusion. Like traditional systemic treatments, biologics target your immune system; however, biologics are much more specific. Biologics are reserved for people with moderate-to-severe psoriasis and when other treatments are not working, as certain criteria have to be met before these treatments are subsidised by the Pharmaceutical Management Agency PHARMAC.
PHARMAC – The Pharmaceutical Management Agency (PHARMAC) is the New Zealand Crown agency that decides, on behalf of District Health Boards, which medicines and related products are subsidized for use in the community and public hospitals.
It is important to remember that your dermatologist is required to have tried all other approaches prior to biologic treatment, as this is one of the criteria for obtaining your treatment subsidised by PHARMAC.
Subsidised biologic treatments include adalimumab, etanercept and infliximab. Biologics can only be prescribed by your dermatologist.
Biologics are a relatively recent group of treatments and their long-term safety is still being evaluated. As biologics work in a different way to other systemic treatments, they may be associated with different side effects. The side effects will vary depending on the treatment you have been prescribed. It is important that the benefits of treatment are weighed against the risks. Speak to your doctor or read the Consumer Medicine Information leaflet that comes with your prescription for further information on side effects specific to your treatment.
Eligibility for a biologic treatment
There are specific criteria you must meet to qualify for PHARMAC funding of a biologic treatment. For example, you must have severe chronic plaque psoriasis with:
- Lesions for at least six months with a PASI score of >15The severity of psoriasis is measured with the Psoriasis Area and Severity Index (PASI) score. It is a scale that takes into account the area of lesion coverage (calculated as the percentage of the affected body surface area) as well as plaque appearance (redness, thickness and scaling). A PASI score of:
- ≤10 suggests mild psoriasis
- >10 suggests moderate-to-severe psoriasis
- Lesions on the face, palm of a hand or sole of a foot and severe/very severe reddening of the skin, thickness and scaling for at least six months
- Lesions that affect >30% of the face, palm of a hand or sole of a foot for at least six months (1% of your body is approximately the same area as the surface of your palm)
Plus, in addition to the above, you must have failed other therapies, including phototherapy and other systemic treatments, before eligibility for these treatments through PHARMAC funding.
When you meet the criteria for a biologic, you may trial alternative biologics without having to meet each one’s initial criteria. This means you don’t have to experience a flare up to swap to an alternative biologic.
What happens if I don’t respond to treatment?
By the time you get to try a biologic, you will have tried and failed numerous treatments. If your first biologic treatment fails you may feel like you are out of options. However, not everyone responds to all treatments in the same way and if you don’t respond to your first therapy, you have up to 2 alternative biologics that you are able to try.
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