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New Therapies for Psoriasis: The Biologics

This new class of drugs are proteins derived from living sources such as humans, animals, plants and microorganisms. They are immunomodulating agents designed to alter pathogenic immune responses.

Amevive® (Alefacept) was the first of the biologics to be approved by the FDA for the treatment of moderate to severe plaque-type psoriasis. This drug decreases the pathogenic T-cells that are most responsible for psoriasis, selectively reducing the pathogenic memory cells and inhibiting T-cell activation. It has a slow onset of action, but a second course of therapy causes an increased response. The drug is administered in the dermatology office via an intramuscular injection. Amevive® is given weekly for 12 weeks followed by a 12- week drug-free period. When it is given in combination with broadband UVB (light therapy), the response improves. There is no long-term safety data available, but infection is known to be a low incidence of infection as a side-effect of this drug. Amevive® is extremely useful in treating patients who have been on long-term Methotrexate or Neoral® to help them terminate those therapies, which have attendant side effects and risks.

Enbrel® (Etanercept) is one of the biologic agents that is approved by the FDA for the treatment of psoriatic arthritis. (The FDA also licensed Enbrel® for treatment of moderate to severe plaque psoriasis in April, 2004.) This agent acts by blocking the activity of inflammatory cytokines. Enbrel® begins to work within 2 to 4 weeks of the start of therapy. Patients are trained in the dermatology office and then self-administer either one 50 mg subcutaneous injection (two 25 mg vials) per week or twice-weekly subcutaneous injections of 25 mg each. Maintenance therapy is required.
Please contact your dermatologist to discuss what therapy, if any, might be best for you. This information is NOT intended to take the place of a visit to the dermatologist. For more information, see the website of the National Psoriasis Foundation at www.psoriasis.org.
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Humira® (Adalimumab) is a biologic agent that blocks TNF which is elevated in certain disease states such as psoriasis & psoriatic arthritis.  It is used to treat moderate to severe chronic plaque psoriasis.
Plaque psoriasis tends to respond within 2-4 weeks after starting the medication.  Patients take a loading dose of 80 mg (2 injections) then the following week 1 injection (40 mg) then 1 injection every other week.  Maintenance therapy is required.

Stelara® (Ustekinumab) -  one of the newer biologic agents that is given 4 times a year after the 2 starter doses.  This medication is administered in the doctor’s office.  Stelara targets your immune system by blocking IL-12 and IL-23, two proteins that play a role in plaque psoriasis.  By preventing these two proteins from attaching to cells in your body, Stelara may slow down the production of skin cells and reduce inflammation.

Remicade® (Infliximab) is indicated for the treatment of adult patients with chronic severe (extensive +/- disabling) plaque psoriasis.  Remicade blocks the action of TNF, a protein that is elevated in psoriasis and other diseases.  Remicade is given via IV infusion at a local infusion center or hospital.  Remicade is infused over a 2 hour period and is weight-based dosing.