While there are a number of biologics available for psoriasis, each have different characteristics that make one more useful than another in a specific patient population and/or rationale.
In terms of speed, defined as time to achieve 50% improvement in baseline PASI scores, brodalumab and ixekizumab showed response in as early as 2 weeks post dose. High-dose secukinumab, adalimumab, and infliximab show a response within 3 to 4 weeks, while ustekinumab after 4 weeks. Instead, etanercept present a response after 6 and 11 weeks with high-dose and low-dose, respectively.1
Etanercept and adalimumab have both demonstrated long-term safety. In detail, etanercept demonstrated safety of up to 10 years while adalimumab demonstrated long-term safety in 23,458 patients with rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis, psoriasis, and Crohn’s disease.6 In addition, TNF blocker usage is associated with a lower incidence of cardiovascular events in patients with rheumatoid arthritis and psoriasis.7-10
Certolizumab is the only biologic safe for use in pregnancy as it lacks the Fc portion and thus cannot cross the placenta. In a study focusing on the concentration of certolizumab in the blood of mothers and cord blood of infants (n=14 mother/infant pairs), only one infant had detectable levels of 0.040 µg/mL in the umbilical cord.11
Use in Obese Patients
Many of the current biologics are effective in patients who are obese. Some may require dose adjustments for weight while others do not (Table).
Use in Psoriatic Arthritis
There are a few main biologics that have shown effectiveness in psoriatic arthritis including:
Present disclosure: The presenter has reported that he receives research funds from Abbvie, Amgen, Boehringer Ingelheim, Celgene, Eli Lilly, Janssen/Johnson & Johnson, Kadmon, Medimmune/Astra Zeneca, Novartis, Pfizer. Henis also a consultant for Allergan, Leopharma, and Promius.
Written by: Debbie Anderson, PhD
Reviewed by: Victor Desmond Mandel, MD