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Multiple biologics supported in new psoriasis guidelines

New guidelines from the American Academy of Dermatology and the National Psoriasis Foundation strongly support the use of a wide range of biologics to treat cases of psoriasis that are insufficiently resolved despite treatment with topical therapy, phototherapy or both.

New guidelines strongly support the use of a wide range of biologics to treat cases of psoriasis that are insufficiently resolved despite treatment with topical therapy, phototherapy or both.

“Biologic agents, as monotherapy or combined with other topical or systemic medications, have a high benefit-to-risk ratio, and because of that, they are a welcome addition to the armamentarium of psoriasis management,” write the authors of the joint guidelines for the American Academy of Dermatology and the National Psoriasis Foundation.

The guidelines, which provide recommendations about biologics therapy for psoriasis, were published online Feb. 13 in the Journal of the American Academy of Dermatology. (https://doi.org/10.1016/j.jaad.2018.11.057)

University of Alabama at Birmingham professor of dermatology Craig A. Elmets, MD, FAAD, co-chair of the work group that developed the joint guidelines, put it this way in an interview with Dermatology Times: “Biologics have revolutionized psoriasis therapy, and many people can have clearing or almost complete clearing of their disease. And many [of the drugs] seem to be safer than alternatives before the biologics such as cyclosporine.”

With guidance listed at a “strength of recommendation” of A, guidelines support the monotherapy use of these TNF-alpha inhibitors for moderate-to-severe psoriasis:

  • etanercept (Enbrel)
  • infliximab (Remicade)
  • adalimumab (Humira)

Another TNF-alpha drug, certolizumab (Cimzia), was FDA-approved in 2018 and “is likely to have class characteristics similar to those of other TNF-α inhibitors regarding treatment combination, efficacy in difficult-to-treat areas, and possibly, immunogenicity,” the guidelines note. “Nevertheless, there is no evidence available on these topics, and these statements are based on extrapolation of data from other TNF-α inhibitors.”

In regard to IL-12/IL-23, IL-17 and IL-23 inhibitors, the guidelines offers “A”-level support for the monotherapy use of these drugs for moderate-to-severe psoriasis:

  • ustekinumab (Stelara)
  • secukinumab (Cosentyx)
  • ixekizumab (Taltz)
  • brodalumab (Siliq)
  • guselkumab (Tremfya)
  • tildrakizumab (Ilumya)

Risankizumab, which is not yet FDA-approved, can also be used in these patients (the strength of recommendation for this guidance is B).

Read on: Multiple biologics supported in new psoriasis guidelines

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