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This is the second installment of a four-part series on biologics and dermatology, further exploring the impact of biologics in the treatment of dermatologic diseases. Future installments will focus on atopic dermatitis and other skin diseases.

Biologics continue to transform the treatment of psoriasis. Dermatologists use terms such as “night and day,” “profoundly different,” and “amazing” to describe the biologics era compared with treatment before biologics became available. Despite these advances, however, challenges remain, with few patients facing high treatment costs, inequitable access, or a lack of response to a particular biologic, whereas few experience an initial benefit that starts to wear off over time.

And regardless of their effectiveness in treating psoriasis, an unanswered question remains: How long do patients need to stay on biologic therapy to maintain their response?

In this second installment of the series on biologics in dermatology, Medscape Dermatology asked several experts to share their perspectives on biologics for treating psoriasis, including how these agents have changed patient quality of life, how biologics fit into systemic therapies overall, and what’s coming next.

No Turning Back

“It’s night and day,” Arun Pathy, MD, a dermatologist for Kaiser Permanente Colorado, said when asked to compare the pre- and post-biologics eras. “I’ve been practicing now for about 35 years. When I first started, we had very limited options for patients with moderate-to-severe psoriasis.”

Pathy frequently prescribed methotrexate in the past, with the risk for “pretty significant side effects,” including liver and kidney problems. “It was not the greatest medication, but that’s what we had,” he said.

Since biologics were introduced and have evolved, “there is very little need to go back to using these older and more toxic medications,” Pathy added.

Avery H. LaChance, MD, MPH, agreed. The emergence of biologics has been “transformative and profoundly different,” she told Medscape Medical News. “Biologics work very quickly and effectively, and because of their fast response, patients describe them as life-changing,” she added.

“I tell all my psoriasis patients now that if you were going to pick a time in the history of the world to have psoriasis, it would be now,” said LaChance, director of the Advanced Psoriasis Therapeutics Clinic at Brigham and Women’s Hospital in Boston. “For the vast, vast majority of our patients, we can essentially put their disease in remission on the appropriate therapeutics.”

Once word got out about the effectiveness of biologic therapies, “so many people came out of the woodwork” for treatment, said Neil J. Korman, MD, PhD, professor of dermatology, Case Western Reserve University, Cleveland.

“Now we can maybe get almost two thirds of patients 100% clear, which is amazing,” added Korman, who is also director of the Clinical Trials Unit in the Department of Dermatology and associate director of the Psoriasis Center of Research Translation at University Hospitals of Cleveland.

“If you’re not using biologics, you’re practicing dermatology in the Stone Age,” he added.

Many Biologic Options

“It’s a constantly evolving picture,” Pathy said. Based on his current experience, the interleukin (IL)-17 inhibitors “seem to be the most effective,” he added, “although if you look at the studies, they’re all pretty good.”

“The IL-23 inhibitors, as well as the IL-17 inhibitors, have very good success rates,” Pathy noted. Korman concurred. “Probably IL-17s or IL-23s. I think they both are outstanding.”

There are some comparison studies of biologics. For example, a 2025 network meta-analysis reviewed the many systemic therapies available for treating moderate-to-severe psoriasis. The authors evaluated 204 studies published up to July 2024 and found that compared with placebo, the biologics infliximab, xeligekimab, bimekizumab, ixekizumab, and risankizumab were the most effective treatments for achieving Psoriasis Area and Severity Index (PASI) 90 in people with moderate ‐ to ‐ severe psoriasis. They also found high-certainty evidence for bimekizumab and moderate-certainty evidence for infliximab, xeligekimab (an IL-17A inhibitor approved for psoriasis in China), ixekizumab, and risankizumab.

In another study published in 2025, an international prospective noninterventional study, i nvestigators found that patients treated with anti-IL-17A biologics had significantly higher odds of achieving PASI 100 and PASI 90 scores than others treated with anti-IL-12/23 and anti-TNF-alpha biologics through 24 months.

Challenges Remain

The cost of biologics can be considerable for some patients and can affect access. Most insurance companies have a formulary, and dermatologists are often restricted to prescribing agents on the list. “Fortunately, biologics are for the most part included as first-line options on a patient’s formulary,” LaChance said.

Insurance companies put up a lot of roadblocks, so it takes a lot of time and energy to prescribe them in some cases, Korman said.

Maintaining remission is another challenge. People stay in remission for a while, “but at some point, it will come back and then we can always restart the medicine,” Pathy said.

Korman said that it can be difficult to tell people on a biologic who have been 100% clear — and have “been that way for a while” — that they can stop treatment with the biologic. “I’ve seen too many times that what happens is it comes roaring back,” he added, noting that researchers are assessing how to lengthen the interval between injections while maintaining effectiveness.

“Sadly, for the most part, we do continue to need therapy to keep patients clear. But we can get patients to a point of pretty significant clearance,” LaChance said.

Not the Only Emerging Therapies

Injectable biologics are not the only systemic therapies to recently emerge for treating psoriasis, including deucravacitinib, an oral tyrosine kinase 2 (TYK2) inhibitor, approved for psoriasis in 2022. Several other TYK2 inhibitors are in development.

So how do biologics compare to these other systemic therapies? “There just hasn’t been as much experience with some of these newer agents,” Pathy said. “But it’s exciting that there are potential oral medications coming onto the market that might have the same degree of efficacy as some of these biologics.”

“Right now, I think the biologics still are on top,” he added.

Other systemic treatments include the PDE4 inhibitor apremilast — approved by the FDA in 2014 for moderate-to-severe psoriasis (and for mild-to-moderate psoriasis in 2021) — and, most recently, the targeted oral peptide/IL-23 receptor antagonist icotrokinra (Icotyde) — approved by the FDA for moderate-to-severe psoriasis in March 2026. “Those are not biologics. They are targeted therapeutics in the oral space. These all have pretty good safety profiles, but until very recently, until Icotyde, their efficacy did lag behind the injectable biologics,” LaChance said.

A Look Ahead

Researchers are also investigating biologics with extended half-lives, perhaps leading to biologics administered as infrequently as twice a year, LaChance said. “That will be a nice option for our patients when they do come to market.”

Recently, 16-week results of a phase 2a study evaluating an IL-23p19 monoclonal antibody with an extended half-life in patients with moderate-to-severe psoriasis were announced by the manufacturer.

“We don’t yet have a cure, but we certainly have beautiful therapies that make almost every patient’s skin disease completely or nearly clear and also prevent and treat bad joint disease as well,” LaChance said. “We’re in a renaissance of our psoriasis treatments.”

Pathy had no relevant disclosures. LaChance disclosed that she is an advisory board member for Biogen, Johnson & Johnson Consumer, and Priovant Therapeutics; a consultant for Atheneum, Guidepoint Global, MEDACorp, and Pfizer; an investigator for Merck and Pfizer; and a speaker for TD Cowen. Korman disclosed that he is a consultant, speaker, and/or investigator for multiple pharmaceutical companies.

Damian McNamara is a freelance contributor to Medscape Medical News. He worked full-time for Medscape and WebMD from 2018 to 2024. Damian has a BA in chemistry and an MA in science, health and environmental reporting/journalism.