Biologics in psoriasis (2008) Dr. Amal Kokandi

What are biologics?  "biologics" are made from human or animal proteins. Biologics have been in use for more than 100 years. Vaccines and insulin are considered biologics because they are derived from living sources.  Approximately 50 biologics are currently being evaluated for their efficacy in treating psoriasis (The Bulletin 2000: 31, 8-9)

Immunology

Amivive (alefacept)  approved in January 2003 by FDA for treating moderate to severe plaque psoriasis  Reduces the number of circulating CD45 RO+ T cells, CD4+ and CD8+ cells  Given by intramuscular injection in a doctor's office once per week for 12 weeks  Additional 12-week treatment cycles might be necessary or recommended

Enbrel (etanercept)  approved in April 2004 by FDA for treating moderate to severe plaque psoriasis  blocks TNF-alpha  Patients give themselves an injection under the skin once or twice per week  Taken continuously to maintain results  May reduce the progression of joint damage

Raptiva (efalizumab)  approved in October 2003 by FDA for treating moderate to severe plaque psoriasis  Blocks interaction between LFA-1 and ICAM-1 (inhibiting T cell activation, cut. T cell trafficking, T cell adhesion to keratinocytes and inhibition of CD11A.  Patients give themselves an injection under the skin once per week  Taken continuously to maintain results

Remicade (infliximab)  approved in May 2005 by the U.S. Food and Drug Administration (FDA) for the treatment of psoriatic arthritis. It is also approved for treating rheumatoid arthritis, ulcerative colitis, ankylosing spondylitis (arthritis affecting the spine) and Crohn's disease psoriatic arthritis psoriatic arthritis  On Sept. 27, 2006, Remicade was approved for the treatment of severe plaque psoriasis  Neutralizes soluble TNF-alfa and blocks TNF-alfa bound to cell membranes

Remicade (infliximab)  Given by three separate, two- to three-hour infusions in a doctor's office during the first six weeks of treatment  Subsequent infusions administered every eight weeks  Patients should be screened for latent (hidden) tuberculosis (TB) before taking Remicade

Humira (adalimumab)  in October 2005 by the U.S. FDA for the treatment of psoriatic arthritis. It is also approved for treating rheumatoid arthritis psoriatic arthritispsoriatic arthritis  blocks tumor necrosis factor-alpha (TNFalpha),  Patients give themselves an injection under the skin every other week  Patients should be screened for latent (hidden) tuberculosis (TB) before taking Humira

Treatments in phase II for psoriasis and/or psoriatic arthritis (march 2007) (17)  ABT-874, AS210 (Psoraxine), Becocalcidiol (Asord), Bimosiamose, BIRT 2584 XX, BMS , CC , CEP-701, Certolizumab pegol (Cimzia), CH-1504, CNTO 1275, CTA018, CTAR398, MM-093, Rambazole, RWJ , and TGAAC94

Treatments in phase III for psoriasis and/or psoriatic arthritis (march 2007) (6)  Adalimumab (Humira), BG-12, CNTO 1275, CNTO 148 (golimumab), Fumaderm, and ISA247