Monitoring biologics for the treatment of psoriasis.
Monitoring patients on therapy consists of 2 parts: evaluation of response and mitigation of risk. Biologics for the treatment of psoriasis are no different. Although laboratory assessments are sometimes necessary, the key elements to appropriate monitoring are clinical assessments and vigilant reinforcement of signs and symptoms, which may portend undesirable adverse effects to the patient. Identifying expected response to therapy establishes one objective of monitoring. There is no precise threshold for response, but given the array of therapies and the relatively high response rates, a 75% improvement in clinical disease state is reasonable. Less well established is a reasonable time over which the expected improvement should occur. For alefacept, there are no data to support a plateau in response. Efalizumab and etanercept show trends to optimal response between 24 and 36 weeks, suggesting at least 6 months of therapy is required to categorically define a treatment failure. Infliximab is contrary to the other 3 biologics showing very thorough response in nearly all patients by week 14 but progressive loss of response during a subsequent 34 weeks of therapy. Categorizing adverse events into simple silos of probability and severity helps identify appropriate monitoring strategies. A greater number of patients treated with longer courses of therapy, coupled with careful observations and reporting, will better define risks and benefits. The better risks and benefits are understood, the more precise monitoring guidelines can be defined.
Papp
Kim A
KA
Probity Medical Research, University of Western Ontario, 135 Union Street East, Waterloo, ON, Canada N2J 1C4. kapapp@probitymedical.com