Psoriasis

What injections or infusions are available for psoriasis? (Continued)

Currently, the main classes of biologic drugs for psoriasis are

  1. TNF (tumor necrosis factor) blockers,
  2. drugs that interfere with interleukin chemical messengers of inflammation.

TNF blockers

TNF blockers include Enbrel (etanercept), Remicade (infliximab), and Humira (adalimumab). TNF-alpha blocking drugs may have an advantage of treating psoriatic arthritis and psoriasis skin disease. Their disadvantage is that some patients may notice a decrease in the effectiveness of TNF-alpha blocking drugs over months to years.

TNF blockers are generally not used in patients with demyelinating (neurological) diseases like multiple sclerosis, congestive heart failure, or patients with severe overall low blood counts called pancytopenia.

The major side effect of these class of drugs is suppression of the immune system. Because of the increased risk of infections while on these drugs, patients should promptly report fevers or signs of infection to their physicians. Minor side effects have included autoimmune conditions like lupus or flares in lupus. Additionally, it is best to avoid any live vaccines while using TNF blockers.

  • Enbrel (etanercept) is a self-injectable medication for home use. It is injected via a small needle just under the skin, called subcutaneous injection. It is usually dosed once or twice week by patients at home after training with their physician or the nursing staff. Sometimes a higher loading dose is used for the first 12 weeks and then it is "stepped down" to half the dose after the first 12 weeks. Enbrel has the advantage of at least 16 years of clinical use and long-term experience.
  • Remicade (infliximab) is an intravenous (IV) medication strictly for physician office or special infusion medical center use. It is dosed specifically based on your weight. It is currently not for home use or self-injection. It is infused slowly over time via a small needle into a vein. After a six-week loading period, it is infused every two months. There have been reports of antibodies to this drug in patients taking it for some time. These antibodies may cause a greater drug-dose requirement for achieving disease improvement or failure to improve. The IV route may be more time-consuming, requiring physician during the infusions. Remicade has the advantage of fast disease response and good potency.
  • Humira (adalimumab) is a self-injectable medication for home use. It is injected via a small needle just under the skin as a subcutaneous dose. It is usually dosed once every other week, totaling 26 injections in one year. Dosing is individualized and should be discussed with your physician. Sometimes a higher loading dose is used for the first dose (80 mg) and then it is continued at 40 mg every other week. It may give results as soon as one to two weeks of therapy. Humira has the advantage of at least 11 years of clinical use and long-term experience.

Drugs that interfere with interleukin mechanisms

  • Ustekinumab is the newest biologic injectable medication used to modulate the immune system. It is an interleukin-12/23 human monoclonal antibody. Ustekinumab targets chemical messengers in the immune system involved in skin inflammation and skin-cell production. This drug is dosed subcutaneously (just under the skin) once a quarter (every three months). It has been very promising with very good clearance rates in the clinical trials. A major advantage may be the convenience of a quarterly medication. The concerns for infection and malignancy may be similar to the other biologics.
Reviewed on 5/2/2014