The development of a number of new specific, rational therapies has been an important advance in the treatment of psoriasis and has led to an important shift in the way that dermatologists manage this chronic disease. Nonetheless, the number of choices that patients are faced with makes the decision as to which biologic they would choose confusing. Before making a decision, discuss your preferences and thoughts regarding the type of therapy you want with your physician as this will help determine the right choice for you.
There are several questions to consider that may help you decide among the biologics.
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What type of psoriasis do I have?
The biologics have been mostly studied in plaque psoriasis. There have been some preliminary case reports showing the effectiveness of infliximab and adalimumab in some of the other subsets of psoriasis, such as pustular psoriasis.
Do I have psoriatic arthritis?
The only approved therapies at this time for psoriatic arthritis are etanercept, adalimumab, and infliximab. There have been some preliminary smaller encouraging studies using alefacept and ustekinumab in psoriatic arthritis; however; these drugs are not approved for psoriatic arthritis in Canada.
How is it given?
Most biologics are self-administered (alefacept, etanercept, adalimumab, and ustekinumab). For patients who wish to self-administer (self-inject) therapies, this would be an important consideration.
For some patients, however, they may prefer to have someone else administer the therapy, such as with infliximab. In this situation, patients go to infusion centers, where they receive therapy over approximately 2 hours. One advantage of these centers is that there are nurses present for counseling, and follow-up of patients is done on a regular basis.
It is expected, however, that if you self-inject (with etanercept, adalimumab, alefacept, or ustekinumab) that you would also follow up regularly in your physician's office. If you have trouble taking medication on a regular basis, or as directed by your physician, this may be a good option for you.
How often do I receive the medication?
The frequency of injection varies from once to twice weekly (etanercept) to every two to three months (infliximab and ustekinumab).
What response can I expect?
It is important to remember that most biologic therapies have not been compared against each other, so it is not possible to directly compare their effectiveness. Still, the response rates from the different studies have been reported.
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Is there a reason why I should not receive this drug?
For each of the drugs, there will be certain patients who should not receive the therapy (contraindication) for specific reasons. To find out more, you can check out Psoriasis Alternative Treatment.