Biologics for psoriasis
Examples
|
| adalimumab | Humira |
| alefacept | Amevive |
| etanercept | Enbrel |
| golimumab | Simponi |
| infliximab | Remicade |
| ustekinumab | Stelara |
These medicines are also called tumor necrosis factor
antagonists (TNF antagonists).
Alefacept is given once a week in
an IV (intravenously) or once a week as a shot in a muscle.
Dosage depends on your body weight. The treatment usually lasts for 12
weeks.
Etanercept is usually given once a week as a shot under the
skin. Adalimumab is given as a shot under the skin every other week. Some
people learn to give themselves the shots at home. Your dosage depends on your body
weight.
Infliximab is given in three 2-hour IV (intravenous) doses
in the doctor's office in the first 6 weeks, then every 4 to 6 weeks.
How It Works
Biologics block harmful responses from the
body's
immune system that lead to the symptoms of
psoriasis.
Why It Is Used
Biologics are used to treat
moderate to severe
chronic plaque psoriasis and
psoriatic arthritis. Alefacept, etanercept, and
infliximab are all approved by the U.S. Food and Drug Administration (FDA) for
the treatment of psoriasis. Adalimumab, etanercept, golimumab, and infliximab
have been approved for treating
psoriatic arthritis.
How Well It Works
These biologics significantly reduce
symptoms of psoriasis, providing rapid and sustained improvement. Continued
treatment can lead to extended remission from symptoms.1, 2, 3, 4
One study showed that etanercept was effective for treating psoriasis in children.5
Side Effects
The most common side effect of these
biologics is an allergic reaction to the injection (shot) or infusion (medicine
given in a vein, intravenously, or IV). If you have a reaction to the shot or
infusion, it will happen right away, either during the infusion or within 1 to
2 hours after the infusion or shot. Your doctor may give you medicines to
prevent or stop the reaction.
Symptoms of a shot or infusion site
reaction include:
- Fever and chills.
- Chest
pain and shortness of breath.
- Itching
and rash.
- Headache.
- Nausea.
- Heat and
redness (flushing) in the
face.
- Fatigue and dizziness.
Warnings have been issued about serious side effects of
these biologics. The U.S. Food and Drug Administration (FDA) and the medicine’s
manufacturers have warned about:
- An increased risk of a serious infection. TNF antagonists affect
your body's ability to fight all infections. So if you get a fever, cold, or
the flu while you are taking this medicine, let your doctor know right
away.
- An increased risk of blood or nervous system disorders. Call
your doctor if you have symptoms of blood disorders (such as bruising or
bleeding) or symptoms of nervous system problems (such as numbness, weakness,
tingling, or vision problems).
- A possible increased risk of
developing
lymphoma (a type of blood cancer). It is not clear
whether this increase is because of the drug or because people with this
disease may already have a higher risk.6 There have
been reports of a rare kind of lymphoma, occurring mostly in children and teens
taking some of these biologics, that often results in death.
- An
increased risk of liver injuries. Call your doctor if your skin starts to look
yellow, if you are very tired, or if you have dark brown urine and/or a
fever.
See Drug Reference for a full list of side effects. (Drug
Reference is not available in all systems.)
What To Think About
The safety of long-term treatment
with biologics is not known.
These medicines probably will have to
be taken for long periods of time—possibly even for life.
Biologics are less likely than some other psoriasis treatments to cause
kidney and liver problems.2
Because
biologics interfere with the
immune system, there is a possibility that they may
raise your risk of infection,
anemia, and possibly even cancer. Medicines that
suppress the immune system are not usually given to people with impaired immune
systems. If you take biologic drugs, you may have periodic tests for
tuberculosis.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
References
Citations
- Abramowicz M (2008). Drugs for acne, rosacea and
psoriasis. Treatment Guidelines From The Medical Letter,
6(75): 75–82.
- Lebwohl M (2003). Psoriasis. Lancet, 361(9364): 1197–1204.
- Reich K, et al. (2005). Infliximab induction and
maintenance therapy for moderate-to-severe psoriasis: A phase III, multicentre,
double-blind trial. Lancet, 366(9494):
1367–1374.
- Krueger GG, et al. (2005). Patient-reported outcomes
of psoriasis improvement with etanercept therapy: Results of a randomized phase
III trial. British Journal of Dermatology, 153(6):
1192–1199.
- Paller AS, et al. (2008). Etanercept treatment for children and adolescents with plaque psoriasis. New England Journal of Medicine, 358(3): 241–251.
- Menter A, Griffiths CEM (2007). Current and future
management of psoriasis. Lancet, 370(9583):
272–284.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
|---|
| Specialist Medical Reviewer | Alexander H. Murray, MD, FRCPC - Dermatology |
|---|
| Last Revised | January 6, 2010 |
|---|
Last Revised:
January 6, 2010
Abramowicz M (2008). Drugs for acne, rosacea and
psoriasis. Treatment Guidelines From The Medical Letter,
6(75): 75–82.
Lebwohl M (2003). Psoriasis. Lancet, 361(9364): 1197–1204.
Reich K, et al. (2005). Infliximab induction and
maintenance therapy for moderate-to-severe psoriasis: A phase III, multicentre,
double-blind trial. Lancet, 366(9494):
1367–1374.
Krueger GG, et al. (2005). Patient-reported outcomes
of psoriasis improvement with etanercept therapy: Results of a randomized phase
III trial. British Journal of Dermatology, 153(6):
1192–1199.
Paller AS, et al. (2008). Etanercept treatment for children and adolescents with plaque psoriasis. New England Journal of Medicine, 358(3): 241–251.
Menter A, Griffiths CEM (2007). Current and future
management of psoriasis. Lancet, 370(9583):
272–284.
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