Advances in Psoriasis Research and Side-by-Side Treatment Review

New Insights, Treatment Updates and Comparisons

Naveed Saleh, MD, MS; Reviewed by Graeme Lipper, MD

Disclosures

May 31, 2017

Table 2. FDA-Approved Biologic Treatments for Moderate to Severe Psoriasis, Based on Pathway

Pathway Examples[12] Dosage in Adults[12] Price Adverse Effects (List Not Exhaustive)[12] Special Notes[12]
TNF blockers a) Etanercept (Enbrel®) 25 mg

b) Infliximab (Remicade®) 100 mg/vial

c) Adalimumab (Humira®) 10 mg/0.2 mL[16]
a) 50 mg subcutaneously twice weekly for 3 months. Maintenance 50 mg weekly.

b) 5 mg/kg/week IV infusion at weeks 0, 2, and 6, followed by once every 8 weeks

c) 80 mg subcutaneously first week followed by 40 mg every other week
a)$93.08/mg[14]

b)$206.95/mg[14]

c)$455/mg[12]
a) Injection-site reactions, infections

b) Infections, infusion reactions

c) Injection-site reactions, infections
a) Black box warning for risk for serious infection and development of malignancy

b) Black box warnings for serious infection risk and malignancy

c) Black box warnings for serious infection and malignancy[16]
IL-12, -23 antagonist Ustekinumab (Stelara®) 45 mg/0.5 mL[17] For adults: < 100 kg, subcutaneous 45 mg initially then 45 mg at 4 weeks, followed by 45 mg every 12 weeks $19,296[12] Infections, hypersensitivity reactions May increase risk for serious infections and cancers
IL-17 antagonists a) Secukinumab (Cosentyx®) 150 mg/mL

b) Ixekizumab (Taltz®) 80 mg/mL
a) 300 mg subcutaneously once weekly at weeks 0-4, then 300 mg every 4 weeks

b) 160 mg subcutaneously at week 0, then 80 mg at weeks 2, 4, 6, 8, 10, and 12, followed by 80 mg every 4 weeks
a) $2327[12]

b) $13,564[12]
a) Upper respiratory infection, diarrhea, nasopharyngitis

b) Infections, injection-site reactions, nausea
a) May exacerbate immune disorders and infection

Outlook

Most people with psoriasis have mild illness with minimal disturbance to activities of daily living. However, psoriasis can be a very serious condition with substantial comorbidity, including cardiovascular and metabolic disease; thus, an integrated approach to healthcare that targets skin problems, systemic inflammation, preventive health, and psychiatric care is imperative. Fortunately, the emergence of biologic agents and immunomodulators offers adjunctive treatment options as well as a better appreciation for the condition among clinicians and researchers.[18]

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