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Biologic Therapy for Psoriasis: BAD 2020 Guidelines - Page 2
Choice of Biologic Therapy
Considerations to take into account before initiating or making changes to biologic therapy are as follows:
- The presence of both psoriasis and psoriatic arthritis, in consultation with a rheumatologist
- Presence and phenotype of psoriatic arthritis, which may influence access to and choice and dose of biologic therapy
The following psoriasis-related factors should be considered when tailoring the choice of biologic agent to the needs of the patient:
- Therapeutic goals
- Disease phenotype and activity pattern
- Disease severity and impact
- Additional presence of psoriatic arthritis
- Outcomes of prior psoriasis treatments
Other individual factors to consider when tailoring the choice of biologic agent to the needs of the patient are as follows:
- Patient age
- Current or past comorbidities
- Pregnancy status and/or conception plans
- Patient body weight
- Patient opinion on drug administration route or dosing frequency
- Likelihood of compliance with treatment
- Drug cost: Administration expense, dosage, price per dose, commercial arrangements
- In adults, offer any of the currently approved biologic therapies as first-line therapy, substituting a different approved biologic should the first one fail.
- Tumor necrosis factor (TNF) antagonists or interleukin 17 antagonists should be offered as first-line therapy for patients with psoriatic arthritis.
- Etanercept can be considered in TNF antagonist–eligible patients if other biologics have failed or cannot be used, or if a short half-life is important.
- Infliximab should be reserved for very severe disease or if age-based dosing is important, or if other biologics have failed or cannot be used.
- For pediatric patients, adalimumab can be offered for patients aged 4 years or older, etanercept for patients aged 6 years or older, or ustekinumab for those aged 12 years or older, if they meet the criteria for biologic therapy.
Contraindications to Biologic Therapies
- Do not use TNF antagonists in people with demyelinating diseases and consider alternative interventions in people who have a first‐degree relative with demyelinating disease.
- Stop treatment and seek specialist advice if neurological symptoms suggestive of demyelinating disease develop during TNF antagonist therapy. Symptoms include loss or reduction of vision in one eye with painful eye movements; double vision; ascending sensory disturbance and/or weakness; problems with balance, unsteadiness or clumsiness; altered sensation travelling down the back and sometimes into the limbs when bending the neck forwards (Lhermitte symptom).
- Avoid TNF antagonist therapy in people with severe cardiac failure [New York Heart Association (NYHA) class III and IV].
- Stop TNF antagonist therapy in the event of new or worsening pre‐existing heart failure and seek specialist advice.
- Exercise caution and consult a gastroenterology specialist before using brodalumab, ixekizumab or secukinumab in people with inflammatory bowel disease.
"British Association of Dermatologists guidelines for biologic therapy for psoriasis 2020: a rapid update," is published in the British Journal of Dermatology.
DOI: https://onlinelibrary.wiley.com/doi/10.1111/bjd.19039
UK: The British Association of Dermatologists have released an updated clinical practical guideline on biologic therapy for psoriasis 2020. The guideline is published in the British Journal of Dermatology.
The overall aim of the guideline is to provide up‐to‐date, evidence‐based recommendations on the use of biologic therapies targeting tumour necrosis factor (TNF) (adalimumab, etanercept, certolizumab pegol, infliximab), interleukin (IL)‐12/23p40 (ustekinumab), IL‐17A (ixekizumab, secukinumab), IL‐17RA (brodalumab) and IL‐23p19 (guselkumab, risankizumab, tildrakizumab) in adults, children and young people for the treatment of psoriasis; consideration is given to the specific needs of people with psoriasis and psoriatic arthritis.
Use of Biologic Therapy
- Biologic therapy for psoriasis should be initiated and supervised only by specialist physicians who are experienced in the diagnosis and treatment of psoriasis. The routine monitoring can be delegated to other healthcare professionals, such as clinical nurse specialists. Other relevant healthcare professionals should be consulted in cases that involve psoriatic arthritis or other multiple comorbidities.
- Coordination of care providers, along with the patient, is necessary with regard to arrangements for drug administration, monitoring, and follow-up.
- Ensure that people with psoriasis who are starting biologic therapy have an opportunity to participate in long-term safety registries.
Criteria for Use of Biologic Therapy
- Criteria for offering biologic therapy are as follows:
- Psoriasis requiring systemic therapy
- Failure of, intolerance to, or contraindications for methotrexate and cyclosporine
- Psoriasis has significant impact on physical, psychological, or social functioning: Extensive (>10% body surface area or Psoriasis Area and Severity Index ≥10) and/or psoriasis is severe at localized sites and is associated with significant functional impairment
- Criteria for considering biologic therapy are as follows:
- Psoriasis that fulfills disease severity criteria and is accompanied by active psoriatic arthritis
- Psoriasis that is persistent (eg, relapses rapidly) when off therapy that cannot be continued long term
Source : British Journal of Dermatology
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: editorial@medicaldialogues.in. Contact no. 011-43720751