Long-term safety of biologics in the treatment of moderate-to-severe plaque psoriasis: review of current data.
Conventional non-biologic systemic agents are regarded as second-line therapy for the treatment of moderate-to-severe plaque psoriasis after topical treatments. However, long-term data have highlighted a number of safety concerns associated with their prolonged use. Biologic agents targeting specific immune mediators have emerged as an alternative treatment option for patients with moderate-to-severe plaque psoriasis who are unresponsive to, or intolerant of, non-biologic systemic agents. Although several biologics have demonstrated good efficacy and tolerability in short-term trials, treatment guidelines recommend them as third-line therapies due to a relative lack of long-term safety data. Here, we have reviewed the long-term (≥ 1 year) safety data from randomized controlled trials, open-label extension studies and meta-analyses of etanercept, infliximab, efalizumab, adalimumab, alefacept and ustekinumab in the treatment of adults with moderate-to-severe plaque psoriasis. With the exception of efalizumab, which has been withdrawn from both the European and U.S. markets due to long-term safety concerns, these biologics are generally well tolerated in long-term studies, and offer a viable alternative to conventional non-biologic agents in patients with moderate-to-severe plaque psoriasis.
Royal Free London Foundation NHS Trust, Pond Street, London NW3 2QG, UK. malcolmrustin@btinternet.com
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D000911:Antibodies, Monoclonal / Q000009:adverse effects; D001688:Biological Products / Q000009:adverse effects*; D003879:Dermatologic Agents / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections / Q000150:complications; D019694:Hepatitis B, Chronic / Q000150:complications; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D011300:Preoperative Care / Q000379:methods; D011565:Psoriasis / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D011993:Recombinant Fusion Proteins / Q000009:adverse effects
D000911:Antibodies, Monoclonal; D001688:Biological Products; D003879:Dermatologic Agents; D011993:Recombinant Fusion Proteins