There have been many discoveries and research in the management of moderate and severe psoriasis for last 2-3 decades. Better understanding about the pathogenesis of psoriasis has led to advance in better treatment options for psoriasis. Traditional systemic treatment for psoriasis like methotrexate, cyclosporine and acitretin are often associated with related side effects especially end organ toxicity. In a search for better treatment options while minimizing the side effects and toxicity has led to the development of new treatment agents, the so-called Biologics.
The use of biologics in the management of moderate and severe psoriasis over past few years have increased with excellent results. These new generation drugs are proteins derived using recombinant DNA technology designed with the understanding of immunogenesis of psoriasis which specifically targets and interfere with the immune system that are responsible for causing psoriasis. Moreover they are thought to limit the potential systemic side effects because of their high specificity directed towards specific pathogenic cells without affecting sells of other organ.
Currently available Biologics For Psoriasis are injectable. They cannot be taken by oral. We’ll review some of the Biologics For Psoriasis currently in used in this article.
Etanercept ( Brand name:Enbrel )
Etanercept inhibits the activity of Tumor necrosis factor alpha( TNF-alpha) a key mediator that triggers inflammation. The current suggested treatment regimen of etanercept is 50 mg administered subcutaneously twice weekly for three months, and then followed by once weekly thereafter. It is approved for the treatment of chronic plaque psoriasis. Study suggests that Etanercept may be a safe for those with hepatitis C. Common side effects may be injection site reaction that may last for 3 to 5 days, cough and respiratory symptoms and infection.
Infliximab ( Brand name:Remicade )
Infliximab is a monoclonal antibody currently approved for treatment of psoriatic arthritis and rheumatoid arthritis. It works the same way as other biologics, blocking the activity of TNF-alpha. In psoriasis patients, infliximab is given intravenously at 3-5 mg/kg body weight over 2 hours at week 0,2 and 6, then after every 8 weeks. Common side effects may be infusion site reaction, nausea, fatigue, joint pain. Every Patients must have tuberculosis skin testing prior to initiation of the therapy to avoid reactivation of latent tuberculosis. Infliximab is not given for patients with severe congestive heart failure or any neurological disease. Details study on drug interaction and safety during pregnancy or nursing mother have not been evaluated.
Adalimumab ( Brand name:Humira )
Like other TNF-alpha blockers (Infliximab, Etanercept ), Adalimumab also works the same way by interrupting the activity of TNF-alpha. Adalimumab is administered subcutaneously with 40 mg over 3-5 minutes every 2 weeks or in some cases every weeks or as directed by your doctor. Common side effects may be injection site reaction, nausea and infection. Every Patients must have tuberculosis skin testing prior to initiation of the therapy to avoid reactivation of latent tuberculosis. This drug is not recommended for breast feeding mothers and may not be safe during pregnancy. Talk to your doctor if you are breastfeeding mother or planning to get pregnant.
Alefacept ( Brand name:Amevive )
Alefacept works by blocking the antigen from binding and activation of T-lymphocytes by attaching itself to the site on T-lymphocyte where antigen attaches. Thus, preventing T-lymphocyte to cause rapid growth of cells and reducing the inflammation of skin. Alefacept is currently being used in adults with moderate to severe plaque psoriasis. Alefacept is administered 15 mg intramuscular or 7.5 mg by intravenous injection per week for 12 weeks. If necessary it can be continued for another additional 12 weeks, but only if T-lymphocyte counts are within the normal range. Some common side effects are nausea, dizziness, muscle ache, sore throat, cough, chills and injection site reaction. Details study on drug interaction and safety during pregnancy or nursing mother have not been evaluated.
Efalizumab ( Brand name:Raptiva )
Efalizumab is a humanised monoclonal antibody that binds to the CD11a subunit of Lymphocyte function-associated antigen 1 ( LFA-1) and blocks adhesion mechanism, thus preventing the activation of lymphocyte which is responsible for inflammatory process in psoriasis. Efalizumab is subcutaneously administered initially as 0.7mg/kg followed by weekly 1 mg/kg injection. The common side effects usually after first 2 injection are chills, headache, nausea and vomiting. Efalizumab is not recommended for children under 18.
Efalizumab was previously approved for the treatment of moderate to severe psoriasis in Europe and USA but now it has been withdrawn from US market due to its increase risk of fetal side effects like progressive multifocal leukoencephalopathy (PML), a rapidly progressive viral infection of the brain that has no known treatment and results in severe disability or even death.
Ustekinumab ( Brand name:Stelara )
Ustekinumab is a human monoclonal antibody that binds to interleukin( IL)-12 and IL-23 and prevents them from binding to T-lymphocytes and activating it. Ustekinumab is new biologics recently approved by FDA for the treatment of moderate to severe psoriasis. Ustekinumab is administered subcutaneously. The current recommended dose for patients weighing less then 100 kg is 45mg initially, 45 mg 4 weeks later then 45 mg every 12 weeks. For patients weighing more then 100 kg, the dose is 90 mg initially, 90 mg after 4 weeks then 90 mg every 12 weeks. Details study on drug interaction and safety during pregnancy or nursing mother have not been evaluated. Ustekinumab (Stelara) is not recommended for children below 18 years of age.
It is important to know that the safety of these drugs for long term use is unknown and these drugs might need to be continued for long term even lifetime. These Biologics For Psoriasis are thought to be less likely fatal then traditional psoriasis treatment, but as these agents interfere with your immune system there may be risk of infection or any serious systemic disorders. These agents are not recommended for those with weak immune system.