title: Biologic fatigue in psoriasis.
abstract: BACKGROUND
  Over the past 15 years, biologic medications have greatly advanced psoriasis therapy. However, these medications may lose their efficacy after long-term use, a concept known as biologic fatigue. We sought to review the available data on biologic fatigue in psoriasis and identify strategies to help clinicians optimally manage patients on biologic medications in order to minimize biologic fatigue.
  
  
  METHODS
  We reviewed phase III clinical trials for the biologic medications used to treat psoriasis and performed a PubMed search for the literature that assessed the loss of response to biologic therapy.
  
  
  RESULTS
  In phase III clinical trials of biologic therapies for the treatment of psoriasis, 20-32% of patients lost their PASI-75 response during 0.8-3.9 years of follow-up. A study using infliximab reported the highest percentage of patients who lost their response (32%) over the shortest time-period (0.8 years). Although not consistently reported across all studies, the presence of antidrug antibodies was associated with the loss of response to treatment with infliximab and adalimumab.
  
  
  CONCLUSIONS
  Biologic fatigue may be most frequent in those patients using infliximab. Further studies are needed to identify risk factors associated with biologic fatigue and to develop meaningful antidrug antibody assays.
authors.affiliation: Department of Dermatology, University of California, Psoriasis and Skin Treatment Center , San Francisco, CA , USA.
authors.forename: Ethan C
authors.initials: EC
authors.lastname: Levin
authors.forename: Rishu
authors.initials: R
authors.lastname: Gupta
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Brown
authors.forename: Mona
authors.initials: M
authors.lastname: Malakouti
authors.forename: John
authors.initials: J
authors.lastname: Koo
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000276:immunology / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000276:immunology / Q000627:therapeutic use*; D001688:Biological Products / Q000008:administration & dosage / Q000276:immunology / Q000627:therapeutic use*; D017326:Clinical Trials, Phase III as Topic; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D000069285:Infliximab; D008297:Male; D011565:Psoriasis / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D018124:Receptors, Tumor Necrosis Factor / Q000037:antagonists & inhibitors*; D000069549:Ustekinumab
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D001688:Biological Products; D018124:Receptors, Tumor Necrosis Factor; D000069285:Infliximab; D000069549:Ustekinumab; D000068879:Adalimumab