Psoriasis Alternative Treatment - How Do I Decide Which Biologic Is Right for Me

Psoriasis Alternative Treatment

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.
 

Psoriasis Alternative Treatment

Ustekinumab For Psoriasis

Ustekinumab For Psoriasis

Ustekinumab was recently approved in Canada and the U.S. for the treatment of psoriasis, but is not approved for the treatment of psoriatic arthritis. Several large studies have been conducted and research is ongoing regarding its use in psoriatic arthritis. 

Ustekinumab is the first of a new class of medications that targets chemical messengers known as interleukin-12 (IL-12) and interleukin-23 (IL-23). These are naturally occurring proteins that are important in regulating the immune system and believed to be associated with certain immune-related inflammatory diseases, such as psoriasis. This new medication regulates IL-12 and IL-23, reducing the inflammation in the skin cells and helping to control the signs and symptoms of psoriasis. Of interest, it is becoming increasingly clear that IL23 and a new type of recently described T-cell (T-helper 17) are of central importance in the development of psoriasis. Interleukin-23 stimulates the growth and the survival of T-helper 17 cells, which may be of central importance in stimulating the skin cell to proliferate, resulting in the changes of psoriasis.
 

Ustekinumab For Psoriasis

Adalimumab Side Effects

Adalimumab Side Effects

What should you tell your doctor while receiving adalimumab?

If you develop any of the following while taking adalimumab, you should contact your doctor immediately:

Infections: If you develop an infection or symptoms of an infection, you might need to stop taking adalimumab, so contact your doctor. If your doctor gives you a treatment for infection, it should be taken right away and as prescribed. Treatment with adalimumab should be stopped if you develop a serious infection. Symptoms may include fever, fatigue, and/or a cough.
 

Adalimumab Side Effects

Adalimumab For Psoriasis

Adalimumab For Psoriasis

This biologic therapy is currently approved in Canada and U.S. for the treatment of adults with rheumatoid arthritis, psoriatic arthritis, and psoriasis. Adalimumab hinds and blocks tumor necrosis factor-alpha (TNF-alpha), a chemical that is made by cells in the immune system and sends faulty signals to the skin and joints. Patients with psoriasis and psoriatic arthritis produce too much TNF-alpha, which results in the inflammation causing red, scaly, skin lesions and swollen, tender joints. 

Adalimumab helps reduce the inflammation by blocking and reducing the amount of TNF-alpha, and interrupting the inflammatory cycle that is seen in psoriasis and psoriatic arthritis. Adalimumab works quite quickly and many patients will notice an improvement within the first month; however, for others it may take up to three or four months to the best improvement.

Adalimumab For Psoriasis

Before Using Etanercept

Before Using Etanercept

What You Should Tell the Doctor before Starting Etanercept 

You should tell your doctor if you: 

• are pregnant or plan on becoming pregnant
• are breast-feeding
• have problems with your immune system (HIV/AIDS) 
• have a history of heart failure
• have a history of cancer
• have tuberculosis, have had it, or have been recently exposed to it; you will need to have a tuberculosis skin test done; if you have tuberculosis, you will need medication to treat the tuberculosis before you start etanercept therapy to prevent worsening of your tuberculosis
• have had a recent severe infection, or are prone to infections or recurring infections
• are taking any other medications or herbal supplements
• have an allergy to etanercept or any of its components
• have problems or diseases with the nervous system such as multiple sclerosis; if you experience any numbness, tingling, or visual changes before, during, or after eranercept treatment, you should tell your doctor; a small number of patients who have received etanercept have experienced a worsening in their multiple sclerosis and other rare diseases of the nervous system

Before Using Infliximab

Before Using Infliximab

What You Should Tell the Doctor before Starting lnfliximab 

You should tell your doctor if you:

• are pregnant or planning on becoming pregnant
• are breast-feeding
• have a history of heart failure
• have problems with your immune system (HIV/AIDS)
• have had a recent severe infection or are prone to chronic or recurring infections
• have, have had, or have been expose to tuberculosis; you will need to have a  skin test done; if you have tuberculosis, you will need medication to treat the tuberculosis before you start infliximab therapy in order to prevent a recurrence of tuberculosis infections
• are taking any medications or herbal supplements
• have had an allergic reaction to infliximab or one of its components
• have a history of liver disease (i.e., hepatitis B)
• have problems or diseases with the nervous system such as multiple sclerosis; if you experience any numbness, tingling, or visual changes before, during, or after infliximab treatment, you should tell your doctor; a small number of patients who have received infliximab have experienced a worsening of their multiple sclerosis and other rare diseases of the nervous system (Guillain-Barre, optic neuritis)

Infliximab Psoriasis Infusion - Tumor Necrosis Factor-Alpha

Infliximab Psoriasis Infusion

People with psoriasis and psoriatic arthritis can produce increased amounts of an important protein (cytokine) known as tumor necrosis factor-alpha or TNF-alpha, which can cause the red, scaly, raised areas of the skin and tender, swollen joints. TNF-alpha is found in higher than normal amounts in the affected skin and joints and can trigger inflammation in these areas. Blocking this inflammatory messenger can reduce inflammation of the joints in psoriatic arthritis, and prevent and treat the appearance of skin lesions in psoriasis.
 
Three biologic agents, etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade), block TNF-alpha and are currently approved in the United States and Canada for the treatment of psoriatic arthritis and psoriasis. These agents can neutralize the undesirable inflammatory effects of TNF-alpha in the skin and joints.

Infliximab Psoriasis Infusion

Alefacept for Psoriasis

Alefacept for Psoriasis

What you Should Tell the Doctor before Starting Alefacept

Alefacept can both affect your normal immune response and make you more susceptible to infections. You should tell your doctor about any other health problems you have now or have had in the past. If any of the following conditions apply, tell your doctor before you start alefacept therapy: 

• are pregnant or are planning to become pregnant
• are breast-feeding
• have had a recent severe infection or are prone to chronic or recurring infections
• have, have had, or have been exposed to tuberculosis
• have a history of immune suppression (such as HIV/AIDS)
• have a history of cancer
• have a history of allergy to alefacept
• are taking any other medications, especially immunosuppressive agents or herbal supplements

Alefacept for Psoriasis

Who Should Not Take Alefacept

• those with a T-cell count lower than 250 cells/microliter
• those who are pregnant or breast-feeding
• those who have a serious infection, or frequent recurrence of serious infections
• those who have HIV/AIDS
• those who have cancer (with the exception of certain types of skin cancer that have been treated)
• those who are allergic to alefacept or any of its components 

What You Should Tell the Doctor While Taking Alefacept 

As always, it is important to follow your doctor's instructions, keep your appointments for injections, and obtain all blood work as directed by your doctor. If you develop any of the following conditions while taking alefacept, immediately contact your doctor.

You experience a decrease in your T-lymphocyte number: 

A decrease in the number of T-lymphocytes (one of the types of white blood cells measured during a complete blood count) is called lymphopenia. If your T-lymphocytes drop below a certain number while on alefacept, your doctor will stop your treatment until they increase (levels of CD4+ T-lymphocyte cells should be greater than 250 cells/microliter). If these levels are below normal prior to starting alefacept treatment, you should not start until your cell count is normal or above normal. Your doctor will determine this before starting therapy. It is important to get your blood work done regularly while on alefacept as directed by your doctor.
 
You develop an infection: 

If you develop an infection or symptoms of an infection, you should contact your doctor. If the infection is mild, it may not be necessary for you to stop treatment. However, certain infections may require you to do so.
Symptoms can include fever, fatigue, and/or a cough. Other symptoms could include a raised, hot, red area of skin that is spreading. If you feel unwell but do not have a fever, it is still important to tell your doctor. Since alefacept can suppress your immune system, your body may not respond to an infection with a fever as it would normally. If you develop a serious infection alefacept should be stopped until it is fully treated. Any medication that your doctor prescribes for the treatment of infections should be taken immediately.
 
You develop cancer (malignancies): 

If you develop cancer while taking alefacept, tell your doctor right away. Alefacept is an immunosuppressant and has a potential to increase your risk of cancer. Alefacept reduces the number of T-cells, which are important in fighting and preventing serious infections and cancer. The role of alefacept in the development of cancer is unknown. In clinical trials, the incidence of cancer in patients treated with alefacept was low and similar to those taking a placebo. Long-term follow-up studies are required to determine the safety of this medication.
 
You become pregnant: 

If you become pregnant while taking alefacept, contact your doctor immediately. In the United States, there is a pregnancy registry that you can enroll in by calling 1-866-263-8483.

You need to receive a vaccine: 

The efficacy and safety of live vaccines administered while a patient is taking alefacept is not known.
 
What Side Effects Can Alefacept Cause?
 
Side effects are possible with any medication, including biologic agents; however, clinical studies have shown that alefacept is well tolerated. There is no evidence of psoriasis rapidly recurring (rebound) after stopping therapy. The most common side effects, experienced by more than 5 percent of patients, were:

• sore throat
• runny nose
• nausea
• fatigue
• diarrhea
• itch
• headaches
• pain, swelling, and redness at the site of injection

Alefacept an immunosuppressant and has the potential to increase your risk of cancer. The role of alefacept in the development of cancer is unknown. In clinical trials, the incidence of cancer in patients treated with alefacept was low and similar to those taking a placebo.

Alefacept for Psoriasis

How Do You Store Alefacept?

When alefacept is administered at your doctor's office, it will usually be provided when you come to the clinic. If a nurse comes to your home and administers the injection, you may have to store the medication.

• Do not use the medicine after the expiry date on either the vial of alefacept or the water used for injection. Do not use after the last day of the last month stamped on either vial.
• The dose pack should be stored in the refrigerator between 36°- 45°F (2°- 8°c).
• If there is not enough room in the refrigerator for the entire dose pack (a vial of dilutant, syringe, needles, bandage, alcohol pack, and gauze pads), it is important that the vial of alefacept is refrigerated. Other parts of the dose pack can be stored at room temperature.
• You might want to take the alefacept out of the refrigerator 30 minutes before you inject, which will allow the medication to warm to room temperature and will be more comfortable for you to inject.
• Once you mix the dilutant with the alefacept, use it immediately.
• If necessary, you can keep the mixed solution in the refrigerator for up to 4 hours. If you don't use it within 4 hours, dispose of the solution.

To find out more, you can check out Alefacept for Psoriasis.