Chapter 053. Eczema and Dermatitis (Part 8) doc

Eczema and Dermatitis Part 8 The evidence implicating psoriasis as a T cell–mediated disorder has directed therapeutic efforts to immunoregulation.. Cyclosporine and other immunosuppre

Chapter 053 Eczema and

Dermatitis

(Part 8)

The evidence implicating psoriasis as a T cell–mediated disorder has directed therapeutic efforts to immunoregulation Cyclosporine and other immunosuppressive agents can be very effective in the treatment of psoriasis, and much attention is currently directed toward the development of biologic agents with more selective immunosuppressive properties and better safety profiles (Table 53-4) Experience with these agents is limited and information regarding combination therapy and adverse events continues to emerge Use of TNF-α inhibitors may worsen congestive heart failure (CHF), and they should be used with caution in those at risk of or known to have CHF Further, none of the immunosuppressive agents used in the treatment of psoriasis should be initiated if the patient has a severe infection; patients on such therapy should be routinely

screened for tuberculosis Malignancies, including a risk or history of certain malignancies, may limit the use of these systemic agents

Table 53-4 Biologics Approved for Psoriasis or Psoriatic Arthritis

Administration Agent

Mecha nism of Action Indic

ation

R oute

Frequ ency

Warnin

gs

Aleface

pt

Anti-CD-2

M

Once weekly x 12 weeks; may repeat

Lympho penia, potential for increased malignancies, serious

infections

Etanerc

ept

Anti TNF-α

Ps, PsA

S

C

Once

or twice weekly

Serious infections, neurologic events, hematologic

events, potential for increased

malignancies

Efalizu

mab

Anti CD-11a

C

Once weekly

Serious infections, potential for increased

malignancies, thrombocytope nia, hemolytic anemia,

psoriasis worsening

Adalim

umab

Anti TNF-α

C

Every other week

Serious infections, neurologic events, potential for

increased malignancies, hypersensitivit

y reactions, hematologic events

Inflixi

mab

Anti TNF-α

infusion followed by infusions at week 2, 6, then every 8 weeks

Serious infections, hepatotoxicity, hematologic events, hypersensitivit

y reactions, neurologic events, potential for increased

malignancies

Ps, psoriasis; PsA, psoriatic arthritis; IM, intramuscular; SC, subcutaneous; TNF, tumor necrosis factor