Table 3.
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.