Biological Medication For Psoriasis (For Professionals)

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

1. 80% of treated individuals achieve an improvement of PASI 70.
2. 40% of treated individuals achieve an improvement of PASI 90.

-Ustekinumab

• for a dosage of 45mg every three months:

1. 70% of treated individuals achieve an improvement of PASI 70.
2. 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