Atopic Dermatitis: a Short Summary
Biological Medication For Psoriasis (For Professionals)
“biologic” systemic treatments
Indications:
-no response to classical systemic treatments have been seen or their usage is contraindicated.
-the PASI (psoriasis area severity index) of at least 15.
Short term response rates
-Adalimumab:
- 70% of treated individuals achieve an improvement of PASI 70
- 45% of treated individuals achieve an improvement of PASI 90
- in both cases, the dosage is of 40mg every 2 weeks, after an induction dosa of 80mg
-Etanercept:
- 35% of treated individuals achieve an improvement of PASI 70 and 10% have an improvement of PASI 90 after a dosage of 2 times 25mg per week.
- 50% of treated individuals achieve an improvement of PASI 70 and 20% have an improvemnet of PASI 90 after a dosage of 2 times 50mg per week.
-Infliximab
- for a dosage of 0.5mg/Kg at weeks 2, 4 and 6
- 80% of treated individuals achieve an improvement of PASI 70.
- 40% of treated individuals achieve an improvement of PASI 90.
-Ustekinumab
- for a dosage of 45mg every three months:
- 70% of treated individuals achieve an improvement of PASI 70.
- 40% of treated individuals achieve an improvement of PASI 90.
-Secukinumab: click link HERE
To summarize, infliximab achieves the fastest results but it requires an intravenous infusion every 6 weeks. With ustekinumab, the improvement of PASI 90 is maintained 76 weeks after initiation of treatment in 63% of patients at a dosage of 90mg and in 45% of patients at a dosage of 45mg. Adalimumab also remains efficacous 2 years after initiation of treatment.
How to start a biologic:
-why start it: it must not have responded to other systemic agents, the severity of PASI must be at least 15.
-which one to chose: adalimumab (anti-TNF), infliximab (anti-TNF), etanercept (anti-TNF), ustekinumab (anti IL-12): no real guidelines exist. Personal experience is therefore a must.
Since then, new biologics have entered the market:
-Secukinumab: click HERE
-2015 update: click HERE
Therapeutic advise according to the histological caracteristics (proven or suspected)
-keratolytics for hyperkeratosis
-2-5% salicylic acid (up to 20% concentration in palar and plantar locations)
-emollients for parakeratosis
-anthralin, topical steroids, vitamin D analogues and phototherapy for psoriasiform hyperplasia
-topical steroids, cyclosporin, fumaric acid and biologics for erythema.
Contributors
Dr Christophe Hsu – dermatologist. Geneva, Switzerland
Source of information: HMDP visiting expert Professor JH Saurat -Singapore – january 2010
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