Psoriasis treatments: Biologic Agents

Adalimumab is a biological medicine used to treat moderate to severe plaque psoriasis and several inflammatory forms of arthritis. It belongs to a group of medicines known as tumour necrosis factor (TNF) inhibitors.

How does it work?

Adalimumab blocks tumour necrosis factor-alpha (TNF-α), a chemical "messenger" in the immune system that signals other cells to cause inflammation. People with psoriasis have increased levels of TNF-α in affected skin and the joints of people with certain types of arthritis.

TNF-α helps activate immune cells, including T cells, leading to inflammation and the rapid growth of skin cells seen in psoriasis. T cells are a type of white blood cell in the body; in psoriasis, once T cells are mistakenly activated, they can trigger inflammation and other immune responses and fuel the development of psoriasis lesions.

Adalimumab helps lower the amount of TNF-α, thus interrupting the inflammatory cycle of psoriasis and leading to improvement in symptoms for many people who take it.

Who can get it?

Biologics are recommended for adults with severe plaque psoriasis when:

• PASI ≥10
• DLQI >10

and conventional systemic treatments have failed, are contraindicated or are not tolerated.

How is it used?

Patients take adalimumab at home every fortnight by giving themselves an injection under the skin (subcutaneously), similar to diabetes patients who give themselves insulin injections. The initial dose is 80mg followed by 40mg given every two weeks after the initial dose. The first dose is 80 mg, followed one week later by 40 mg. Thereafter, 40 mg is given every other week by subcutaneous injection.

What are the side effects?

Adalimumab should not be administered in patients with active TB, opportunistic or other severe infections, moderate to severe heart failure (NYHA lll/lV) or known hypersensitivity to adalimumab.

Before initiation of therapy with adalimumab, all patients must be evaluated for infection, including active and latent TB. Patients must be actively and regularly monitored for infections during and for 5 months after treatment. Patients should also be evaluated for non-melanoma skin cancer prior to and during treatment.

Other serious side effects have been reported including:

• Infections/sepsis
• Opportunistic infections
• TB
• Demyelinating disease
• Malignancies including lymphoma and skin cancers

• Reactivation of hepatitis B

• Cytopenia
• Worsening heart failure
• Anaphylaxis

Safety advice

• TB screening before treatment
• hepatitis B screening
• avoiding live vaccines
• recognising signs of infection
• regular monitoring throughout treatment

How do I get adalimumab?

Today it is usually initiated by a consultant dermatologist or rheumatologist, with prescribing often continuing through hospital or homecare services.

Available Gudiance

National Institute for Health and Care Excellence (NICE) guidance
Scottish Medicine Consortium guidance
All Wales Medicines Strategy Group
Department of Health,(Northern Ireland)

Adalimumab is known commercially as:

Amgevita, Humira, Hyrimoz, Idacio, Imraldi and Yuflyma

Reviewed: August 2026

Version ID: 2/BIO/PST/08/26

Bimekizumab is a biologic medicine used to treat adults with moderate to severe plaque psoriasis who are suitable for systemic treatment (medicines that work throughout the body).

How does it work?

Bimekizumab selectively binds to IL-17A, IL-17F and IL-17AF. By blocking IL-17A and IL-17F, bimekizumab reduces inflammation in the skin and helps slow the overproduction of skin cells that causes psoriasis plaques.

Who can get it?

Before treatment patients are usually screened for:

• tuberculosis
• hepatitis B (and sometimes hepatitis C)
• other infections

Bimekizumab is for adults with severe plaque psoriasis when:

• the disease has not responded to other systemic treatments,
• or those treatments are unsuitable or not tolerated.

How is it used?

The recommended dose for adult patients with plaque psoriasis is 320 mg (given as 2 subcutaneous injections of 160 mg each) at week 0, 4, 8, 12, 16 and every 8 weeks thereafter.

Consideration should be given to discontinuing treatment in patients who have shown no improvement by 16 weeks of treatment.

What are the side effects?

Serious side effects

• fever, flu-like symptoms, night sweats
• feeling tired or short of breath, cough which will not go away
• warm, red and painful skin, or a painful skin rash with blisters

Very common (may affect more than 1 in 10 people)

• upper respiratory infections with symptoms such as sore throat and stuffy nose Common (may affect up to 1 in 10 people)
• blocking IL-17 increases susceptibility to Candida (thrush), which is the characteristic adverse effect of this class of medicinesfungal infection of the skin, such as athlete’s foot between the toes
• ear infections
• cold sores (herpes simplex infections)
• stomach flu (gastroenteritis)
• inflamed hair follicles which may look like pimples
• headache
• itchy, dry skin or an eczema-like rash sometimes with swollen and reddened skin (dermatitis)
• acne
• redness, pain or swelling at the site of injection
• feeling tired Uncommon (may affect up to 1 in 100 people)
• lowered levels of white blood cells (neutropenia)
• fungal infections of the skin and mucous membranes (including oesophageal candidiasis)
• discharge from the eye with itching, redness and swelling (conjunctivitis)
• blood in the stool, abdominal cramps and pain, diarrhoea or weight loss (signs of bowel problems)
• inflammatory bowel disease (can develop or worsen)
• liver monitoring is not routine
• hypersensitivity reactions

You should seek medical advice if you develop persistent diarrhoea, abdominal pain or blood in your stools, as these may be signs of inflammatory bowel disease.

How do I get bimekizumab

Bimekizumab is prescribed by a specialist and is usually self-administered at home after appropriate training.

Available Guidance

National Institute for Health and Care Excellence (NICE) guidance
Scottish Medicine Consortium guidance
All Wales Medicines Strategy Group
Department of Health (Northern Ireland)

Marketed by

Bimekizumab is known commercially as Bimzelx and is marketed in the UK by UCB Pharma Ltd

Reviewed: August 2026

Version ID: 2/BIM/PST/08/26

Brodalumab is a monoclonal antibody (a type of biologic medicine) used to treat adults with moderate to severe plaque psoriasis.

How does it work?
Brodalumab works by binding to the interleukin-17 receptor A (IL-17RA). This blocks the activity of several inflammatory proteins, including IL-17A, IL-17F and IL-25, reducing inflammation and slowing the rapid growth of skin cells seen in psoriasis.

Who can get it?
Brodalumab is recommended for adults with severe plaque psoriasis when:

• the disease has not responded to conventional systemic therapies,
• those treatments are unsuitable,
• or they are not tolerated.

How is it used?
The recommended dose is 210 mg given as a subcutaneous injection at weeks 0, 1 and 2, followed by 210 mg every two weeks. After appropriate training, most people give the injections themselves at home.

What are the side effects?

Crohns Disease
Brodalumab should not be used in patients with active Crohn's disease.  Patients with a history of Crohn's disease require careful monitoring. If patients develop active Crohn's disease, treatment should be discontinued permanently.

Suicidal ideation and behaviour
Suicidal ideation and behaviour, including completed suicide, have been reported in patients treated with Brodalumab. The majority of patients with suicidal behaviour had a history of depression and/or suicidal ideation or behaviour. A causal association between treatment with Brodalumab and increased risk of suicidal ideation and behaviour has not been established.

The risk and benefit of treatment with Brodalumab should be carefully weighed for patients with a history of depression and/or suicidal ideation or behaviour, or for patients who develop such symptoms. Patients, caregivers, and families should be advised of the need to be alert for the emergence or worsening of depression, suicidal ideation, anxiety, or other mood changes, and they should contact their healthcare provider if such events occur. If a patient suffers from new or worsening symptoms of depression and/or suicidal ideation or behaviour is identified, it is recommended to discontinue treatment with Brodalumab.

Infections
Brodalumab may increase the risk of infections. Caution should be exercised when considering the use of Brodalumab in patients with a chronic infection or a history of recurrent infection. Patients should be instructed to seek medical advice if signs or symptoms suggestive of an infection occur. If a patient develops a serious infection, the patient should be closely monitored and Brodalumab should not be administered until the infection resolves.

No cases of active tuberculosis were reported from clinical trials. However, Brodalumab should not be given to patients with active tuberculosis. Anti-tuberculosis therapy should be considered prior to initiation of Brodalumab in patients with latent tuberculosis.

Other serious side effects have been reported including:

Common

• Influenza
• Tinea infections (including tinea pedis, tinea versicolor, tinea cruris)
• Neutropenia
• Headache
• Eye disorders
• Oropharyngeal pain
• Diarrhoea
• Nausea
• Arthralgia
• Myalgia
• Fatigue
• Injection site reactions (including injection site erythema, pain, pruritus, bruising, haemorrhage)
• upper respiratory tract infections (common)
• oral candidiasis (common within the broader Candida category)

Uncommon

• Candida infections (including oral, genital, and oesophageal infections)
• Conjunctivitis

Before treatment patients will usually be assessed for:

• tuberculosis
• hepatitis B (where appropriate)
• other infections
• vaccination status

During treatment advise patients to seek medical advice if they develop:

• persistent fever
• signs of infection
• severe diarrhoea or symptoms of Crohn's disease
• changes in mood or suicidal thoughts

 How do I get brodalumab?

Brodalumab is prescribed by a specialist dermatologist and is usually supplied through hospital or homecare services. Most people administer the injections themselves after appropriate training.

Available Gudiance

National Institute for Health and Care Excellence (NICE) guidance

Scottish Medicine Consortium guidance

All Wales Medicines Strategy Group

Department of Health (Northern Ireland)

Marketed by

Brodalumab is known commercially in the UK (and Europe) as Kyntheum (210 mg solution for injection in pre-filled syringe) and is marketed in the UK by LEO Pharma.

In the United States of America the product is commercially known as Siliq.

Reviewed: August 2026

Version ID: 2/BRO/PST/08/26

Certolizumab pegol is a biologic medicine used to treat adults with moderate to severe plaque psoriasis who are suitable for systemic treatment (medicines that work throughout the body).

How does it work?

Certolizumab pegol blocks tumour necrosis factor-alpha (TNF-α), a chemical ‘messenger’ in the immune system that signals other cells to cause inflammation. People with psoriasis have increased levels of TNF-α in affected skin, contributing to inflammation and the rapid growth of skin cells. TNF-α can also lead to increased immune system activity through the activation of immune cells, including T-cells. T-cells are a type of white blood cell in the body. In psoriasis, once T-cells are mistakenly activated, they can trigger inflammation and other immune responses and fuel the development of psoriasis lesions.

Certolizumab pegol helps lower the amount of TNF-α, thus interrupting the inflammatory cycle of psoriasis and leading to improvement in symptoms for many people who receive it.

Who can get it?

NICE recommends certolizumab pegol for adults with severe plaque psoriasis when:

• conventional systemic treatments have failed,
• are contraindicated,
• or are not tolerated.

How is it used?

Treatment starts with 400 mg (given as two injections of 200 mg) at weeks 0, 2 and 4. After this, the usual maintenance dose is 200 mg every two weeks. Some people may receive a different dosing schedule based on their response to treatment.

What are the side effects?

Serious side effects (seek urgent medical advice)

• signs of severe infection
• allergic reactions
• unexplained bruising or bleeding
• worsening heart failure
• severe skin reactions
• symptoms suggestive of tuberculosis

Common side effects

• upper respiratory infections
• headache
• rash
• injection-site reactions
• nausea
• fatigue

Before treatment patients are usually screened for:

• tuberculosis
• hepatitis B (where appropriate)
• other infections

Vaccination

Live vaccines should generally be avoided during treatment.

How do I get certolizumab pegol

Certolizumab pegol is prescribed by a specialist and is usually self-injected at home after appropriate training.

Available Guidance

National Institute for Health and Care Excellence (NICE) guidance
Scottish Medicine Consortium guidance
All Wales Medicines Strategy Group
Department of Health (Northern Ireland)

Marketed by

Certolizumab pegol is known commercially as Cimzia and is marketed in the UK by UCB Pharma Ltd

Reviewed: August 2026

Version ID: 2/CEP/PST/08/26

Etanercept is a biologic medicine used to treat moderate to severe plaque psoriasis, psoriatic arthritis and several other inflammatory conditions. It belongs to a group of medicines called tumour necrosis factor (TNF) inhibitors.

How does it work?

Etanercept blocks tumour necrosis factor-alpha (TNF-alpha), a chemical "messenger" in the immune system that signals other cells to cause inflammation. People with psoriasis have increased levels of TNF-α in affected skin, contributing to inflammation and the rapid turnover of skin cells.
TNF-α can also lead to increased immune system activity through the activation of T-cells. T-cells are a type of white blood cell in the body; in psoriasis, once T-cells are mistakenly activated, they can trigger inflammation and other immune responses and fuel the development of psoriasis lesions.
Etanercept helps lower the amount of TNF-α, thus interrupting the inflammatory cycle of psoriasis and psoriatic arthritis and leading to improvement in symptoms for many people who take it.

Who can get it?

NICE recommends etanercept for adults with severe chronic plaque psoriasis when:

• conventional systemic therapies have failed,
• are contraindicated,
• or are not tolerated.

How is it used?

The usual starting dose for adults with plaque psoriasis is 50 mg given by subcutaneous injection twice weekly for the first 12 weeks. If treatment is continued, the usual maintenance dose is 50 mg once weekly. Your specialist will regularly review your response to treatment and decide whether it should continue.

What are the side effects?

Common side effects are:

• dizziness
• sore throat
• cough
• stomach pain
• injection site reactions (redness, itching, pain, swelling)
• upper respiratory infections
• headache
• rhinitis (irritation of the nose)

These side effects were generally mild and did not cause most patients to stop taking etanercept. These events happened most often after the first dose of etanercept and may decrease after additional doses.

Less common side effects

• serious infections (including tuberculosis)
• allergic reactions
• injection-site reactions (already included)
• worsening heart failure
• blood disorders
• demyelinating disorders
• lupus-like syndrome
• non-melanoma skin cancer (rare)

Patients should also be advised to seek urgent medical advice if they develop signs of infection.

Before treatment

Patients are usually screened for:

• tuberculosis
• hepatitis B (where appropriate)
• other infections

Vaccinations

Live vaccines should generally be avoided while receiving etanercept.

How do I get etanercept?

Etanercept is available by prescription, primarily from rheumatologists and dermatologists.

Available Gudiance

National Institute for Health and Care Excellence (NICE) guidance

Scottish Medicine Consortium guidance

All Wales Medicines Strategy Group

Department of Health (Northern Ireland)

Etanercept is known commercially as:
Benepali, Enbrel and Erelzi

Reviewed: August 2026

Version ID: 2/ETA/PST/08/26

Guselkumab is a biologic medicine used to treat adults with moderate to severe plaque psoriasis who are suitable for systemic treatment (medicines that work throughout the body).

How does it work?

Guselkumab is a monoclonal antibody that selectively targets interleukin-23 (IL-23), an important protein involved in the inflammation that causes psoriasis. By blocking IL-23, it reduces inflammation and slows the overproduction of skin cells, helping to clear psoriasis plaques.

Who can get it?

It is for use in adults with moderate to severe plaque psoriasis when:

• conventional systemic treatments have failed,
• are contraindicated,
• or are not tolerated.

It can improve the condition of the skin and appearance of nails and reduce symptoms, such as scaling, shedding, flaking, itching, pain and burning.

How is it used?

Guselkumab is given as a subcutaneous injection. The usual dose is 100 mg at week 0, another 100 mg at week 4, followed by 100 mg every 8 weeks thereafter.

What are the side effects?

Serious side effects:

Possible serious allergic reaction (may affect up to 1 in 100 people) - the signs may include: -

• difficulty breathing or swallowing
• swelling of the face, lips, tongue or throat
• severe itching of the skin, with a red rash or raised bumps

Mild to moderate side effects

Some side effects are very common (may affect more than 1 in 10 people):

• respiratory tract infections
• headache
• joint pain (arthralgia)
• diarrhoea
• redness, irritation or pain at the injection site
• increased level of liver enzymes in the blood

Some side effects are uncommon (may affect up to 1 in 100 people):

• allergic reaction
• skin rash
• decreased number of a type of white blood cell called neutrophils
• herpes simplex infections - fungal infection of the skin, for instance between the toes (e.g., athlete’s foot)
• stomach flu (gastroenteritis)
• hives

Seek medical advice if symptoms of infection develop.

Before treatment

Patients are usually assessed for:

• tuberculosis
• infections
• vaccination status

During treatment

Patients should seek medical advice if they develop:

• persistent fever
• signs of infection
• symptoms of an allergic reaction

Vaccinations

Live vaccines should generally be avoided during treatment.

How do I get Guselkumab

Guselkumab is prescribed by a specialist dermatologist. After appropriate training, most people administer the injections themselves at home.

Available Guidance

National Institute for Health and Care Excellence (NICE) guidance
Scottish Medicine Consortium guidance
All Wales Medicines Strategy Group
Department of Health (Northern Ireland)

Marketed by

Guselkumab is known commercially as Tremfya and is marketed in the UK by Janssen-Cilag Ltd

Reviewed: August 2026

Version ID: 2/GUS/PST/08/26

Infliximab is a biologic medicine used to treat adults with moderate to severe plaque psoriasis when conventional systemic treatments have not worked, are not suitable or are not tolerated.

How does it work?

Infliximab blocks tumour necrosis factor-alpha (TNF-α), a chemical "messenger" in the immune system that signals other cells? to cause inflammation. People with psoriasis have increased levels of TNF-α in affected skin, contributing to inflammation and the rapid growth of skin cells.

TNF-α can also lead to increased immune system activity through the activation of immune cells, including T-cells. T-cells are a type of white blood cell in the body; in psoriasis, once T-cells are mistakenly activated, they can trigger inflammation and other immune responses and fuel the development of psoriasis lesions.

Infliximab helps lower the amount of TNF-α, thus interrupting the inflammatory cycle of psoriasis and leading to improvement in symptoms for many people who take it.

Who can get it?

Infliximab is for use in adults with severe plaque psoriasis when:

• conventional systemic therapies have failed,
• are contraindicated,
• or are not tolerated.

How is it used?

Infliximab is given by intravenous infusion in hospital. The usual dose is 5 mg/kg at weeks 0, 2 and 6, followed by an infusion every 8 weeks. Each infusion usually takes around 2 hours, although some patients who tolerate treatment well may be able to receive shorter infusions in accordance with local practice.

What are the side effects?

The most common side effects of infliximab are:

Viral infections, fever, headache, vertigo, dizziness, flushing, upper or lower respiratory tract infection, dyspnoea, sinusitis, GI upset, skin reactions, fatigue, chest pain, increased transaminases, infusion-related reactions. Delayed hypersensitivity reactions may occur if patient retreated after a drug free interval. Signs and symptoms include: myalgia and or/arthralgia with fever and/or rash, with some patients experiencing pruritus, facial, hand and lip oedema, dysphagia, urticaria, sore throat and headache. Rare, usually fatal, hepatosplenic T-cell lymphoma (this has been reported very rarely, mainly in younger patients receiving infliximab with other immunosuppressive medicines for inflammatory bowel disease).

Safety information

• serious bacterial infections
• tuberculosis
• opportunistic infections
• hepatitis B reactivation
• worsening heart failure
• demyelinating disorders
• lupus-like syndrome
• severe allergic reactions

Before treatment patients are usually screened for:

• tuberculosis
• hepatitis B (and sometimes hepatitis C)
• infections
• heart failure where appropriate

 Vaccinations

Live vaccines should generally be avoided during treatment.

How do I get infliximab?

Infliximab is prescribed by a specialist and is administered in hospital or an infusion unit under medical supervision.

Further guidance

National Institute for Health and Care Excellence (NICE) guidance
Scottish Medicine Consortium guidance All Wales Medicines Strategy Group
Department of Health (Northern Ireland)

Infliximab is known commercially as: Flixabi, Inflectra, Remicade, Remsima and Zessly

Reviewed: August 2026

Version ID: 2/INF/PST/08/26

Ixekizumab is a biologic medicine used to treat adults with moderate to severe plaque psoriasis who require systemic treatment (medicines that work throughout the body).How does it work?

By blocking IL-17A, ixekizumab reduces inflammation and helps improve psoriasis symptoms such as scaling, redness, itching and pain. It is used to treat “plaque psoriasis” in adults with moderate to severe disease. It reduces the signs and symptoms of scaling, itching and pain.

Who can get it?

It is for use in adults with severe plaque psoriasis when:

• conventional systemic treatments have failed,
• are not tolerated,
• or are unsuitable.
  
  

How is it used?

Ixekizumab is given by injection under the skin (subcutaneous injection).

The recommended starting dose is 160 mg (two 80 mg injections) at week 0, followed by 80 mg every two weeks until week 12. After this, the usual maintenance dose is 80 mg every four weeks.If there is no response after 16 – 20 weeks the treatment should be reassessed.

What are the side effects?

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Serious side effects

Possible serious infection (may affect up to 1 in 100 people) - the signs may include:

• fever, flu-like symptoms, night sweats
  •   feeling tired or short of breath, cough which will not go away
  •   warm, red and painful skin, or a painful skin rash with blisters

Serious allergic reaction - the signs may include:

• difficulty breathing or swallowing
• swelling of the face, lips, tongue or throat
• severe itching of the skin, with a red rash or raised bumps

Other side effects that have been reported

Some side effects are very common (may affect more than 1 in 10 people):

• upper respiratory tract infections with symptoms such as sore throat and stuffy nose (nasopharyngitis).
• injection site reactions (e.g. red skin, pain).

Some side effects are common (may affect up to 1 in 10 people):

• nausea (feeling sick).
• tinea (fungal) infections such as athlete’s foot.
• pain in the back of the throat.

Some side effects are uncommon (may affect up to 1 in 100 people):

• oral thrush (oral candidiasis).
• runny nose.
• bacterial skin infection.
• discharge from the eye with itching, redness and swelling (conjunctivitis).
• signs of low levels of white blood cells, such as fever, sore throat or mouth ulcers due to infections (neutropenia).
• low blood platelet count (thrombocytopenia).

Patients should seek medical advice if they develop:

• persistent diarrhoea
• abdominal pain
• blood in the stool

Before treatment patients are usually screened for:

• tuberculosis
• infections
• vaccination status

How do I get Ixekizumab?

Ixekizumab is prescribed by a specialist dermatologist. After appropriate training, most people administer the injections themselves at home.

Available Gudiance
National Institute for Health and Care Excellence (NICE) guidance
Scottish Medicine Consortium guidance
All Wales Medicines Strategy Group
Department of Health (Northern Ireland)

Marketed by

Ixekizumab is known commercially as Taltz and is marketed in the UK by Eli Lilly and Company Limited.

Reviewed: August 2026

Version ID: 2/ETA/PST/08/26

Risankizumab is a biologic medicine used to treat adults with moderate to severe plaque psoriasis who are suitable for systemic treatment (medicines that work throughout the body).

How does it work?

Risankizumab works by selectively blocking interleukin-23 (IL-23), a protein involved in the inflammation that causes psoriasis. By reducing IL-23 activity, it helps decrease inflammation and slows the overproduction of skin cells.

Who can get it?

It is for for adults with severe plaque psoriasis when conventional systemic treatments have failed, are unsuitable or are not tolerated.

How is it used?

Risankizumab is given as a subcutaneous injection. The usual dose is 150 mg at week 0, another 150 mg at week 4, followed by 150 mg every 12 weeks. Most people administer the injection themselves after appropriate training.

What are the side effects?

Serious side effects

• fever, flu-like symptoms, night sweats
• feeling tired or short of breath, cough which will not go away
• warm, red and painful skin, or a painful skin rash with blisters

Very common: may affect more than 1 in 10 people

• upper respiratory infections with symptoms such as sore throat and stuffy nose

Common: may affect up to 1 in 10 people

• feeling tired
• fungal skin infection
• injection site reactions (such as redness or pain)
• itching
• headache

Uncommon: may affect up to 1 in 100 people

• small raised red bumps on the skin

Before treatment

Patients are usually assessed for:

• tuberculosis
• infections
• vaccination status

During treatment

Patients should seek medical advice if they develop:

• persistent fever
• signs of infection
• symptoms of an allergic reaction

 How do I get risankizumab?

Risankizumab is prescribed by a specialist dermatologist. After appropriate training, most people administer the injections themselves at home.

Available Guidance

National Institute for Health and Care Excellence (NICE) guidance
Scottish Medicine Consortium guidance
All Wales Medicines Strategy Group
Department of Health (Northern Ireland)

Marketed by

Risankizumab is known commercially as Skyrizi and is marketed in the UK by AbbVie Ltd.

Reviewed: August 2026

Version ID: 2/RIS/PST/08/26

Secukinumab is a biologic medicine used to treat adults with moderate to severe plaque psoriasis who require systemic treatment.

How does it work?
Secukinumab is a monoclonal antibody that selectively binds to and neutralises interleukin-17A (IL-17A), a protein involved in the development of psoriasis and found in significantly higher concentrations in psoriasis-affected skin. This inhibits the release of proinflammatory cytokines, chemokines and mediators of tissue damage and reduces IL-17A-mediated contributions to autoimmune and inflammatory diseases.

Who can get it?
For psoriasis, secukinumab is licensed for adults with moderate to severe plaque psoriasis who are candidates for systemic therapy.

Do not use if:

• you are allergic to secukinumab or any of the other ingredients of this medicine
• you have an active infection which your doctor thinks is important.

Warnings and precautions .  Tell your doctor or pharmacist before using secukinumab if:

• you currently have an infection or if you have long-term or repeated infections.
• you have tuberculosis.
• you have ever had an allergic reaction to latex.
• you have Crohn’s disease.
• you have recently had a vaccination or if you are due to have a vaccination during treatment with secukinumab
• you are receiving any other treatment for psoriasis, such as another immunosuppressant or phototherapy with ultraviolet (UV) light.

How is it used?
Secukinumab is given as an injection. You and your health care provider should decide if you should inject secukinumab yourself of whether it should be done in a hospital setting. It is important not to try to inject yourself until you have been trained by your doctor, nurse or pharmacist. A caregiver may also give you your injection after proper training.

The recommended dose is 300 mg by subcutaneous injection at weeks 0, 1, 2, 3 and 4, followed by 300 mg every four weeks. Depending on the device supplied, the dose may be given as one 300 mg injection or two 150 mg injections.

What are the side effects?

• Serious side effects

Stop using secukinumab and tell your doctor or seek medical help immediately if you get any of the following side effects.

• fever, flu-like symptoms, night sweats
• feeling tired or short of breath, cough which will not go away
• warm, red and painful skin, or a painful skin rash with blisters
• burning sensation when passing urine.
  
  

Serious allergic reaction - the signs may include: 

• difficulty breathing or swallowing
• low blood pressure, which can cause dizziness or light-headedness
• swelling of the face, lips, tongue or throat
• severe itching of the skin, with a red rash or raised bumps.
  
  

Some side effects are very common (may affect more than 1 in 10 people): 

• upper respiratory tract infections with symptoms such as sore throat and stuffy nose (nasopharyngitis, rhinitis)
• cold sores (oral herpes)
• diarrhoea
• itchy rash (urticaria) 4
• runny nose (rhinorrhoea)

Some side effects are uncommon (may affect up to 1 in 100 people): 

• oral thrush (oral candidiasis)
• signs of low levels of white blood cells, such as fever, sore throat or mouth ulcers due to infections (neutropenia)
• athlete’s foot (tinea pedis)
• infection of the external ear (otitis externa)
• discharge from the eye with itching, redness and swelling (conjunctivitis).

• Inflammatory bowel disease
• New onset or worsening Crohn's disease and ulcerative colitis have been reported.

Patients should seek medical advice if they develop:

• persistent diarrhoea
• abdominal pain
• blood in the stool

Before treatment

Patients are usually assessed for:

• tuberculosis
• infection
• vaccination status

Further guidance

National Institute for Health and Care Excellence (NICE) guidance
Scottish Medicine Consortium guidance
All Wales Medicines Strategy Group
Department of Health (Northern Ireland)

Marketed by
Secukinumab is known commercially as Cosentyx and is marketed by Novartis.

Reviewed: August 2026

Version ID: 2/RIS/PST/08/26

Tildrakizumab is a biologic medicine used to treat adults with moderate to severe plaque psoriasis who require systemic treatment (medicines that work throughout the body).

How does it work?

Tildrakizumab selectively blocks interleukin-23 (IL-23), a protein that plays an important role in the inflammation associated with psoriasis. By reducing IL-23 activity, it helps decrease inflammation and improves psoriasis symptoms.

Who can get it?

It is for use in adults with moderate to severe plaque psoriasis when conventional systemic treatments have failed, are not tolerated or are unsuitable. Using tildrakizumab can help with skin clearance and reducing psoriasis symptoms.

How is it used?

The usual dose is 100 mg at week 0, week 4 and then every 12 weeks. In some patients, such as those weighing 90 kg or more, a 200 mg dose may be recommended by the specialist.

What are the side effects?

Serious side effects

• swelling of the face, lips or throat
• breathing difficulties

Very common side effects (may affect more than 1 in 10 people):

• upper respiratory infections

Common side effects (may affect up to 1 in 10 people):

• gastroenteritis
• nausea
• diarrhoea
• injection site pain
• back pain
• headache

Seek medical advice if they develop signs of infection, such as:

• fever
• persistent cough
• flu-like symptoms

 Before treatment patients are usually assessed for:

• tuberculosis
• active infections
• vaccination status

How do I get tildrakizumab?

Tildrakizumab is prescribed by a specialist dermatologist. After appropriate training, most people administer the injections themselves at home.

Available Guidance

National Institute for Health and Care Excellence (NICE) guidance
Scottish Medicine Consortium guidance
All Wales Medicines Strategy Group
Department of Health (Northern Ireland)

Marketed by

Tildrakizumab is known commercially as Ilumetri and is marketed in the UK by Almirall Ltd.

Reviewed: August 2026

Version ID: 2/TIL/PST/08/26

Ustekinumab is a biologic medicine used to treat adults and children aged 6 years and over with moderate to severe plaque psoriasis who require systemic treatment.

How does it work?

Ustekinumab is a monoclonal antibody that blocks the activity of two proteins involved in inflammation, interleukin-12 (IL-12) and interleukin-23 (IL-23). These proteins play an important role in the immune processes that cause psoriasis. By blocking them, ustekinumab reduces inflammation and helps improve psoriasis symptoms.

Who can get it?

Ustekinumab is for use in adults and children aged 6 years and older with moderate to severe plaque psoriasis when other therapies, including ciclosporin, methotrexate and PUVA, are ineffective, not tolerated or contraindicated. 

How is it used?

Starting dose: For body weight under 100kg, initially take 45mg by subcutaneous injection and for body weight over 100kg, initially take 90mg by subcutaneous injection. Repeat the dose after 4 weeks then every 12 weeks thereafter. Consider stopping therapy if no response after 28 weeks.

What are the side effects?

Common side effects include (but are not limited to): Upper respiratory tract infection, nasopharyngitis, cellulitis, depression, dizziness, headache, pharyngolaryngeal pain, nasal congestion, diarrhoea, pruritus, back pain, myalgia, fatigue, injection site reactions

Precautions
Screen for TB prior to therapy; initiate treatment of latent TB before starting therapy. Do not start if active TB found; monitor for active TB during and after treatment. Consider anti-TB therapy prior to treatment for patients with a history of latent or active disease in whom an adequate course of TB treatment cannot be confirmed. Instruct patients to report any signs or symptoms of infection; if serious infection develops, monitor closely and do not administer until resolved. Increased risk of malignancy; caution in patients with a history of malignancy or who develop malignancy during treatment. Discontinue immediately in case of anaphylactic or other serious allergic reaction. Upper respiratory tract infection, nasopharyngitis, cellulitis, depression, dizziness, headache, pharyngolaryngeal pain, nasal congestion, diarrhoea, pruritus, back pain, myalgia, fatigue, injection site reactions.

In patients with psoriasis, exfoliative dermatitis has been reported following ustekinumab treatment. Patients with plaque psoriasis may develop erythrodermic psoriasis, with symptoms that may be clinically indistinguishable from exfoliative dermatitis, as part of the natural course of their disease. As part of the monitoring of the patient’s psoriasis, physicians should be alert for symptoms of erythrodermic psoriasis or exfoliative dermatitis. If these symptoms occur, appropriate therapy should be instituted. STELARA should be discontinued if a drug reaction is suspected.

Patients should seek medical advice if they develop:

• fever
• persistent cough
• unexplained infections

How do I get ustekinumab?

Ustekinumab is prescribed by a specialist dermatologist. After appropriate training, most people administer the injections themselves at home.

Available Guidance

National Institute for Health and Care Excellence (NICE) guidance

Scottish Medicine Consortium guidance

All Wales Medicines Strategy Group

Department of Health (Northern Ireland)

Ustekinumab is known commercially as:  

Reviewed: August 2026

Version ID: 2/UST/PST/08/26