Biologics for psoriasis

Examples

A shot (injection) or IV (intravenous infusion)

Generic Name	Brand Name
adalimumab	Humira
alefacept	Amevive
etanercept	Enbrel
infliximab	Remicade

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. 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

Biologics block harmful responses from the body's immune system that lead to the symptoms of psoriasis.

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. Etanercept, infliximab, and adalimumab have been approved for treating psoriatic arthritis.

How Well It Works

These biologics significantly reduce symptoms of psoriasis, providing rapid and sustained improvement. Continued treatment can lead to extended remission from symptoms.^{1, 2, 3, 4}

Side Effects

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.
• Chills.
• Chest pain.
• Shortness of breath.
• Itching (pruritus).
• Headache.
• Nausea.
• Heat and redness (flushing) in the face.
• Rash.
• Fatigue.
• 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.⁵ 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.

People with a weakened immune system, such as those infected with HIV, should not take alefacept (Amevive). Alefacept can cause some infections to get worse more quickly or may increase complications.

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Author:	Maria G. Essig, MS, ELS	Last Updated: December 10, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Alexander H. Murray, MD, FRCPC - Dermatology
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