Biologics for psoriasis
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These medicines are also called tumor necrosis factor antagonists (TNF antagonists).
Alefacept is given once a week in an IV (intravenously) or once a week as a shot in a muscle. Dosage depends on your body weight. The treatment usually lasts for 12 weeks.
Etanercept is usually given once a week as a shot under the skin. Adalimumab is given as a shot under the skin every other week. Some people learn to give themselves the shots at home. Your dosage depends on your body weight.
Infliximab is given in three 2-hour IV (intravenous) doses in the doctor's office in the first 6 weeks, then every 4 to 6 weeks.
How It Works
Why It Is Used
Biologics are used to treat moderate to severe chronic plaque psoriasis and psoriatic arthritis. Alefacept, etanercept, and infliximab are all approved by the U.S. Food and Drug Administration (FDA) for the treatment of psoriasis. Adalimumab, etanercept, golimumab, and infliximab have been approved for treating psoriatic arthritis.
How Well It Works
One study showed that etanercept was effective for treating psoriasis in children.5
The most common side effect of these biologics is an allergic reaction to the injection (shot) or infusion (medicine given in a vein, intravenously, or IV). If you have a reaction to the shot or infusion, it will happen right away, either during the infusion or within 1 to 2 hours after the infusion or shot. Your doctor may give you medicines to prevent or stop the reaction.
Symptoms of a shot or infusion site reaction include:
- Fever and chills.
- Chest pain and shortness of breath.
- Itching and rash.
- Heat and redness (flushing) in the face.
- Fatigue and dizziness.
Warnings have been issued about serious side effects of these biologics. The U.S. Food and Drug Administration (FDA) and the medicine’s manufacturers have warned about:
- An increased risk of a serious infection. TNF antagonists affect your body's ability to fight all infections. So if you get a fever, cold, or the flu while you are taking this medicine, let your doctor know right away.
- An increased risk of blood or nervous system disorders. Call your doctor if you have symptoms of blood disorders (such as bruising or bleeding) or symptoms of nervous system problems (such as numbness, weakness, tingling, or vision problems).
- A possible increased risk of developing lymphoma (a type of blood cancer). It is not clear whether this increase is because of the drug or because people with this disease may already have a higher risk.6 There have been reports of a rare kind of lymphoma, occurring mostly in children and teens taking some of these biologics, that often results in death.
- An increased risk of liver injuries. Call your doctor if your skin starts to look yellow, if you are very tired, or if you have dark brown urine and/or a fever.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
The safety of long-term treatment with biologics is not known.
These medicines probably will have to be taken for long periods of time—possibly even for life.
Biologics are less likely than some other psoriasis treatments to cause kidney and liver problems.2
Because biologics interfere with the immune system, there is a possibility that they may raise your risk of infection, anemia, and possibly even cancer. Medicines that suppress the immune system are not usually given to people with impaired immune systems. If you take biologic drugs, you may have periodic tests for tuberculosis.
- Abramowicz M (2008). Drugs for acne, rosacea and psoriasis. Treatment Guidelines From The Medical Letter, 6(75): 75–82.
- Lebwohl M (2003). Psoriasis. Lancet, 361(9364): 1197–1204.
- Reich K, et al. (2005). Infliximab induction and maintenance therapy for moderate-to-severe psoriasis: A phase III, multicentre, double-blind trial. Lancet, 366(9494): 1367–1374.
- Krueger GG, et al. (2005). Patient-reported outcomes of psoriasis improvement with etanercept therapy: Results of a randomized phase III trial. British Journal of Dermatology, 153(6): 1192–1199.
- Paller AS, et al. (2008). Etanercept treatment for children and adolescents with plaque psoriasis. New England Journal of Medicine, 358(3): 241–251.
- Menter A, Griffiths CEM (2007). Current and future management of psoriasis. Lancet, 370(9583): 272–284.
Last Updated: December 26, 2009