Biologic therapies in the treatment of psoriasis: A comprehensive evidence-based basic science and clinical review and a practical guide to tuberculosis monitoring

Raja K Sivamani, Heidi Goodarzi, Miki Shirakawa Garcia, Siba P Raychaudhuri, Lisa N. Wehrli, Yoko Ono, Emanual Michael Maverakis

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

The treatment of psoriasis has undergone a revolution with the advent of biologic therapies including infliximab, etanercept, adalimumab, efalizumab, golimumab, certolizumab, alefacept, secukinumab, abatacept, and ustekinumab. These medications are designed to target specific components of the immune system and are a major technological advancement over traditional immunosuppressive medications. Herein, we present a comprehensive, unbiased comparison of these medications focusing on their differences. For example, TNF antagonists can differ in the way they are dissolved and administered, the effector molecules they can bind, serum peak and trough levels, the types of intracellular signals they can induce, the in vivo complexes that they can form, their protein structure, and their incidence and timing of rare adverse events, among other things. A critical review of the clinical studies that have tested the efficacy of these molecules is also presented including head-to-head comparison trials. The safety of biologics in terms of their long-term adverse events is discussed, as is their use in different types of psoriasis and in different patient populations. Finally, all anti-TNF agents have been associated with a variety of serious and "routine" opportunistic infections, particularly tuberculosis. For this reason, anti-tuberculosis testing both prior to the initiation of a biologic therapy and annually during treatment is pertinent. The uses and limitations of both the tuberculin skin test (TST) and QuantiFeron®-TB Gold (QFT) are discussed, as is the care of patients who present with latent tuberculosis infection prior to the initiation of biologic therapy. Recommendations for tuberculosis monitoring are provided.

Original languageEnglish (US)
Pages (from-to)121-140
Number of pages20
JournalClinical Reviews in Allergy and Immunology
Volume44
Issue number2
DOIs
StatePublished - 2013

Fingerprint

Biological Therapy
Psoriasis
Tuberculosis
Latent Tuberculosis
Tuberculin Test
Opportunistic Infections
Immunosuppressive Agents
Skin Tests
Biological Products
Gold
Immune System
Patient Care
Therapeutics
Safety
Incidence
Serum
Population
Proteins

Keywords

  • Abatacept
  • Adalimumab
  • Alfecept
  • Biologics
  • Briakinumab
  • Certolizumab
  • Efalizumab
  • Etanercept
  • Golimumab
  • Infliximab
  • Psoriasis
  • Quantiferon
  • Secukinumab
  • TNF
  • Tuberculosis
  • Ustekinumab

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

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title = "Biologic therapies in the treatment of psoriasis: A comprehensive evidence-based basic science and clinical review and a practical guide to tuberculosis monitoring",
abstract = "The treatment of psoriasis has undergone a revolution with the advent of biologic therapies including infliximab, etanercept, adalimumab, efalizumab, golimumab, certolizumab, alefacept, secukinumab, abatacept, and ustekinumab. These medications are designed to target specific components of the immune system and are a major technological advancement over traditional immunosuppressive medications. Herein, we present a comprehensive, unbiased comparison of these medications focusing on their differences. For example, TNF antagonists can differ in the way they are dissolved and administered, the effector molecules they can bind, serum peak and trough levels, the types of intracellular signals they can induce, the in vivo complexes that they can form, their protein structure, and their incidence and timing of rare adverse events, among other things. A critical review of the clinical studies that have tested the efficacy of these molecules is also presented including head-to-head comparison trials. The safety of biologics in terms of their long-term adverse events is discussed, as is their use in different types of psoriasis and in different patient populations. Finally, all anti-TNF agents have been associated with a variety of serious and {"}routine{"} opportunistic infections, particularly tuberculosis. For this reason, anti-tuberculosis testing both prior to the initiation of a biologic therapy and annually during treatment is pertinent. The uses and limitations of both the tuberculin skin test (TST) and QuantiFeron{\circledR}-TB Gold (QFT) are discussed, as is the care of patients who present with latent tuberculosis infection prior to the initiation of biologic therapy. Recommendations for tuberculosis monitoring are provided.",
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author = "Sivamani, {Raja K} and Heidi Goodarzi and Garcia, {Miki Shirakawa} and Raychaudhuri, {Siba P} and Wehrli, {Lisa N.} and Yoko Ono and Maverakis, {Emanual Michael}",
year = "2013",
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T2 - A comprehensive evidence-based basic science and clinical review and a practical guide to tuberculosis monitoring

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AU - Goodarzi, Heidi

AU - Garcia, Miki Shirakawa

AU - Raychaudhuri, Siba P

AU - Wehrli, Lisa N.

AU - Ono, Yoko

AU - Maverakis, Emanual Michael

PY - 2013

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AB - The treatment of psoriasis has undergone a revolution with the advent of biologic therapies including infliximab, etanercept, adalimumab, efalizumab, golimumab, certolizumab, alefacept, secukinumab, abatacept, and ustekinumab. These medications are designed to target specific components of the immune system and are a major technological advancement over traditional immunosuppressive medications. Herein, we present a comprehensive, unbiased comparison of these medications focusing on their differences. For example, TNF antagonists can differ in the way they are dissolved and administered, the effector molecules they can bind, serum peak and trough levels, the types of intracellular signals they can induce, the in vivo complexes that they can form, their protein structure, and their incidence and timing of rare adverse events, among other things. A critical review of the clinical studies that have tested the efficacy of these molecules is also presented including head-to-head comparison trials. The safety of biologics in terms of their long-term adverse events is discussed, as is their use in different types of psoriasis and in different patient populations. Finally, all anti-TNF agents have been associated with a variety of serious and "routine" opportunistic infections, particularly tuberculosis. For this reason, anti-tuberculosis testing both prior to the initiation of a biologic therapy and annually during treatment is pertinent. The uses and limitations of both the tuberculin skin test (TST) and QuantiFeron®-TB Gold (QFT) are discussed, as is the care of patients who present with latent tuberculosis infection prior to the initiation of biologic therapy. Recommendations for tuberculosis monitoring are provided.

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KW - Tuberculosis

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