Use of biologic therapeutics in difficult-to-treat psoriasis.
Author(s): Lynde C
Affiliation(s): Department of Medicine, University of Toronto, Toronto, ON. derma@lynderm.com
Publication date & source: 2009-01, J Cutan Med Surg., 13(1):6-17.
Publication type: Research Support, Non-U.S. Gov't
BACKGROUND: A need for improved psoriasis management drove the development of four biologicals now approved for use in moderate to severe psoriasis: alefacept, efalizumab, etanercept, and infliximab. OBJECTIVE: This review compares the recommended and practical use of biologicals in "difficult-to-treat" psoriasis. Difficult-to-treat patients, a subpopulation of particular interest to caregivers and regulators, are those for whom conventional options are unavailable, contraindicated, intolerable, or ineffective. CONCLUSIONS: Despite guidance recommending that biologicals be considered among first-line antipsoriasis treatments, formulary inclusion may be influenced by the biologicals' success in controlling difficult-to-treat psoriasis. Findings from the Clinical Experience Acquired with Raptiva (CLEAR) randomized controlled trial (RCT) established efalizumab's equal efficacy in difficult-to-treat and moderate to severe psoriasis. The CLEAR data were cited in support of a regulatory recommendation to include efalizumab in Canadian provincial formularies. For some other biologicals, evidence regarding efficacy in difficult-to-treat psoriasis remains equivocal. Additional RCTs are needed to define appropriate roles for specific biologicals in difficult-to-treat patients.
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