New Therapies for Psoriasis: The Biologics

This new class of drugs are proteins that are 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 acts by decreasing the pathogenic T-cells that are most responsible for psoriasis. This selectively reduces the pathogenic memory cells and inhibits T-cell activation. This drug has a slow onset of action, however, a second course of therapy causes an increased response. The drug is administered in the dermatologist's office via an intramuscular injection. Amevive is given weekly for 12 weeks followed by a 12 week drug-free period. Given in combination with broadband UVB (light therapy), the response is improved. There is no longterm safety data available, however, there is a low-risk of infection while on this drug. Amevive is extremely useful in treating patients that have been on longterm Methotrexate or Neoral, to help them get off those therapies which have attendant side effects and risks.

Raptiva (Efalizumab) was just recently (10/27/03) approved by the FDA to treat moderate to severe plaque-type psoriasis. This drug acts by inhibiting T-cell activation. Raptiva has a relatively rapid onset of action, sometimes within 2 weeks after onset, compared to Amevive. These subcutaneous injections are self-administered weekly by the patient at home, after being trained in the dermatologist's office. Remission is short-lived, so maintenance therapy is necessary.

Enbrel (Etanercept) is the only biologic agent that is approved by the FDA for the treatment of psoriatic arthritis. Approval for the treatment of psoriasis is pending. This agent acts by blocking the activity of inflammatory cytokines. Enbrel begins to work withing 2-4 weeks of therapy. Patients are trained in the doctor's office and then self-administer either (1) 50 mg (=[2] 25 mg vials) subcutaneous injection per week or twice-weekly subcutaneous injections of 25 mg. 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. Also, visit the national psoriasis website for additional information.

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