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 the only biologic agent 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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