1. TNF a inhibitors BY: MOHAMMED ALSAIDAN

2. Biologics Biologic agents are proteins that can be extracted from animal tissue or produced by recombinant DNA technology and possess pharmacologic activity

3. TNF a TNF a is a major cytokine produced by Th1 cells, APC and keratinocytes TNF a in the lesion and serum level correlate with severity of psoriasis TNF potentiate Th1 response, up-regulate intracellular and vascular adhesion, cause keratinocytes proliferation and potentiate other cytokines

6. TNF a adverse effects Viral, bacterial and mycobacterial infections (less with etanercept) ( HCV ?!) Neurologic disease Heart disease Drug induced lupus-like syndrome Hepatic disease (infliximab) Lymphoma Melanoma and non-melanoma skin cancer Haematologic disease

7. Monitoring PPD +/- CXR CBC, U/E, LFT Hepatitis panel ANA

9. Injections Should not be frozen Stable for 14 days Allow for return to room temp before injection Site : thigh, abdomen, upper arms Rotate injection site

11. Indications for Etanercept FDA approved for psoriasis and psoriatic arthritis Off label dermatologic uses: Neutrophilic dermatoses: PG, behcet, aphthous stomatitis Bullous dermatoses: PV, CP Sarcoidosis DM, relapsing polychondritis GVHD, hidradenitis suppurativa, multicentric reticulohistiocytosis

16. T cell activation inhibitors

21. IL 12/23 blockage (Ustekinumab) The p40 subunit of IL 12 is overexpressed in psoriasis It is a human monoclonal antibody Superior to etenercept Given 45 mg S.C at weeks: 0,4, 16, 28

22. THANK YOU