Table 3.

Key points of biologic agents approved for the treatment of psoriasis49–57

Biologic	Mechanism of action	Administration	Efficacy as PASI 75 (phase III trials)	Particular safety issues	Comment
Alefacept	Recombinant fusion protein. Inhibits CD2 from interacting with LFA-3	15 mg IM qw for 12 weeks, stop 12 weeks, restart another 12 weeks	At week 14, 21% (Lebwohl et al51)	Lymphopenia (decrease in CD4 count)	Low rate of responders. Patients who do respond, enjoy a long-term psoriasis remission and one of the best safety profiles among biologics
Adalimumab	Fully human monoclonal antibody. Binds soluble and transmembrane TNF-α	80 mg SC loading dose, then 40 mg SC qow	At week 16, 71% (Menter et al53)	Injection site reactions, reactivation of TB, demyelinating disorders, and contraindicated in CHF	Balance between efficacy and safety. Convenient dosing schedule
Etanercept	Receptor antibody fusion protein. Binds soluble TNF-α and lymphotoxin	50 mg SC biw for 12 weeks, followed by 50 mg qw	At week 12, 49% (Papp et al54)	Injection site reactions, reactivation of TB, demyelinating disorders, and contraindicated in CHF	Balance between efficacy and safety. Has been evaluated for pediatric psoriasis
Infliximab	Chimeric monoclonal antibody. Binds soluble and transmembrane TNF-α	5 mg/kg IV at weeks 0, 2, 6, and followed by q8w	At week 10, 80% (Reich et al56)	Infusion reactions, reactivation of TB, demyelinating disorders, and contraindicated in CHF	Rapid disease control. Used for unstable conditions such as erythrodermic or pustular psoriasis

Abbreviations: PASI, Psoriasis Area and Severity Index; IM, intramuscular; SC, subcutaneous; IV, intravenous; qw, once weekly; qow, every other week; biw, twice weekly; q8w, every 8 weeks. TB, tuberculosis; CHF, congestive heart failure.