With newer biologics enriching the armentarium of Dermatologists almost everyday,it is often difficult to recollect all the information at a time.This powerpoint helps to summarise the pathogenesis of psoriasis as well asdifferent aspects of use of biologics in a nutshell.

1. BIOLOGICS IN PSORIASIS
DR. Ananya Chandra
MD(Dermatology,Venereology & Leprosy)

13. ELIGIBILITY CRITERIA
A. Severe disease
B. Fulfil at least one of the following clinical
categories
 When phototherapy or alternative standard
systemic therapy are contraindicated
 Intolerant to standard systemic therapy
 Unresponsive to standard systemic therapy
 Have significant comorbidity which precludes
the use of standard systemic therapy
 Severe,unstable, life threatening disease

14. STEPS WHILE STARTING
BIOLOGIC AGENT
1)Counselling
2)Pre-treatment history &
investigations
3)Planning vaccination
4)Choosing biologics

15. WHICH ONE TO CHOOSE
1) Rapidity of response
desired
2) Comorbidities
3) Facilities
4) Administering
biologic
5) Cost
6) Follow up

16. WHICH ONE TO CHOOSE
1) Rapidity of response
desired
2) Comorbidities
3) Facilities
4) Administering
biologic
5) Cost
6) Follow up

17. CHOICE OF BIOLOGICS WITH COMORBIDITIES
COMORBIDITIES BIOLOGIC
Tubeculosis Secukinumab
HBV/HCV Secukinumab
HIV Etanercept
Psoriatic arthropathy Adalimumab/Secukinumab
Multiple sclerosis Secukinumab
CHF Secukinumab

18. CHOICE OF BIOLOGICS WITH COMORBIDITIES
COMORBIDITIES BIOLOGIC
Coronary artery disease Anti- TNFα therapy
IBD Anti- TNFα therapy
Autoimmune disease Use biologics with caution
CLD of noninfectious etiology Etanercept/Adalimumab
CRF Etanercept
Cancer No data available
Obesity Secukinumab

19. AT A GLANCE
DRUG
DOSING
SCHEDULE TOXICITY
ETANERCEPT 25/50 mg twice weekly sc for 12
weeks and then weekly
Inj site reactions,
URTI,Lupus like
syndrome,CHF
worsening,TB reactivation
ADALIMUMAB 80 mg on D1 f/b 40 mg every
other week
Inj site reaction,reactivation
of TB
INFLIXIMAB 3-5 mg/kg 0,2,6 wks and 8 wkly
thereafter
Infusion
reactions,ADA,reactivation
of TB
ITOLIZUMAB 1.6mg/kg as IV infusion every 2
wk for 12 wk f/b once in 4 wk for
24 wk
Acute infusion
reaction,diarrohoea
SECUKINUMAB 300 mg sc 0,1,2,3,4 wk f/b
monthly maintainence dose
Nasopharyngitis,
Candidiasis,
Neutropenia

22. COMBINATION WITH BIOLOGICS
BIOLOGIC NBUVB MTX ACITRETIN CsA
ETANERCEPT Rescue
therapy
Faster
clearence
Decreased dose Rescue therapy
(?)
ADALIMUMAB Rescue/bridg
e/concomitan
t/maintenanc
e
No studies Decreased dose Rescue therapy
(?)
INFLIXIMAB Rescue
therapy (?)
Decreased ADA Rescue/
Maintenance
therapy
Avoid
SECUKINUMAB No studies No studies No studies No studies

23. BIOLOGICS IN SPECIAL SITUATIONS
ETARNACEPT
ADALIMUMAB
USTEKINUMAB
INFLIXIMAB
ETARNACEPT
ADALIMUMAB
INFLIXIMAB

24. SWITCHING BIOLOGICS
INEFFICACY ADVERSE EFFECTS
Can be switched over
to different drug of
same class or new
class
Switched over to drug of
NEW CLASS (infectious
complications, CHF,
multiple sclerosis while on
TNFα blocker)
OR
drug of SAME CLASS(e.g-
in case of ADA)

25. INDICATIONS OF
STOPPING BIOLOGICS
a) Fail to achieve adequate response
b) A serious adverse effect
c) Pregnancy(temporary withdrawal)
d) Elective surgical
procedure(temporary withdrawal)

26. HOW LONG TO USE?????????

27. Upcoming Biologics
DRUG TARGET
IXEKIZUMAB IL17A
BRODALUMAB IL17RA
GUSELKUMAB IL-23p19
TILDRAKIUMAB IL-23p19
RISANKIZUMAB IL-23p19
CERTOLIZUMAB TNFα
BIMEKIZUMAB IL17A&F
NEIHULIZUMAB CD162 on TCELL
NAMILUMAB GM CSF
BRIAKINUMAB IL 12 & 23
MIRIKIZUMAB IL-23p19

28. TAKE HOME MESSAGE
Psoriasis has tremendous psychosocial impact.
Insights into immunopathogenesis of psoriasis
have led to discovery of numerous new
therapies.
Biologics are a better treatment option with
improved outcomes
Amongst all the biologics, SECUKINUMAB
provides the highest efficacy and QOL
response with a favourable safety profile