Why Psoriasis Biologics Don’t Work the Same for Everyone

If you’re living with psoriasis, you’ve probably heard stories of someone whose skin completely cleared after starting a biologic while you’re still searching for the treatment that works for you. New research suggests there may be a reason for that.

As reported by Dermatology Times, a study published in the Journal of the American Academy of Dermatology suggests psoriasis isn’t exactly the same disease from one person to the next. While it may look similar on the surface, what’s happening inside the immune system can vary from patient to patient, which could help explain why certain medications work better for some people than others.

Biologics, including medications like Skyrizi, Cosentyx, Tremfya, Bimzelx and Humira, are injectable or infused medications that target specific parts of the immune system responsible for the inflammation that causes psoriasis. They’ve transformed treatment for moderate to severe psoriasis, helping many patients achieve dramatically clearer skin. But they aren’t one-size-fits-all, and finding the right one can sometimes take time.

In the new study, researchers looked at skin samples from people with chronic plaque psoriasis and found something unexpected. In addition to the well-known inflammatory pathway that most current biologics target, some patients showed signs of additional inflammation that today’s treatments may not fully address. Researchers also found evidence that the skin barrier itself may be more disrupted in certain patients than previously understood.

That doesn’t mean current biologics aren’t effective. In fact, they’re still considered the gold standard for many people with moderate to severe psoriasis. But the findings suggest there may be more than one “version” of psoriasis happening beneath the surface, which could explain why one medication works incredibly well for one person but delivers only modest results for another.

The research could shape how physicians approach psoriasis care and help dermatologists to better predict which biologic is most likely to work before treatment even begins, making the process far less trial and error. It also uncovered several potential biomarkers, or measurable signs in the body, that could one day help personalize treatment even further. More research is needed before those findings can be used in everyday practice, but they offer another step toward more individualized care.

For patients, the message is reassuring: If one biologic doesn’t give you the results you’re hoping for, it doesn’t necessarily mean another won’t. As researchers continue to unravel the science behind psoriasis, the future of treatment looks increasingly personalized.

Adapted from original reporting by Dermatology Times.