The Evolving Role of Biologics in the Treatment of Pediatric Psoriasis.
Department of Dermatology, University of California San Francisco, San Francisco, CA, USA.Skin therapy letter 02/2013; 18(2):1-4.
The exact role of biologics in the treatment of pediatric psoriasis remains undefined but is evolving. Biologics are an attractive option for use in children in part because they offer more convenient dosing regimens and less frequent laboratory monitoring than traditional systemic agents. Further, because their action is targeted, they theoretically lack many of the potential end-organ toxicities of traditional agents. However, compared to adult psoriasis populations, there is a relative lack of long-term safety data specific to the pediatric psoriasis population. Thus, the clear advantages of using biologic agents must be balanced with a measure of caution. This article will provide a summary of the cumulative pediatric safety and efficacy data for the anti-tumor necrosis factor-alpha (TNF-α) agents and interleukin (IL)-12 and IL-23 (IL12/23) pathway inhibitor and suggestions for a rational clinical approach to their use in children with psoriasis.
- "Concerning ustekinumab, only one case reports its use as treatment of plaque psoriasis in a boy aged 14 years . However, the efficacy and safety of ustekinumab in adolescent patients with psoriasis are under evaluation in a multicenter, randomized, doubleblind , placebo-controlled, phase III trial . "
Article: Psoriasis in Children: A Review[Show abstract] [Hide abstract]
ABSTRACT: Psoriasis is a chronic, immune-mediated, inflammatory systemic disease which target primarily the skin. It presents a genetic basis, affecting 1 to 3% of the white population. Nevertheless, the existence of two psoriasis incidence peaks has been suggested (one in adolescence before 20 years of age and another in adulthood) onset may occur at any age, including childhood and adolescence, in which its prevalence ranges between 0.7% and 1.2%. As for adult psoriasis, pediatric psoriasis has recently been associated with obesity, metabolic syndrome, increased waist circumference percentiles, and metabolic laboratory abnormalities, warranting early monitoring and lifestyle modifications. In addition, due to psoriasis chronic nature and frequently occurring relapses, psoriatic patients tend to have an impaired quality of life, often requiring long-term treatment. Therefore, education of both pediatric patients and their parents is essential to successful and safe disease management. However, systemic treatment of children is challenging as the absence of standardized guidelines and the fact that evidence-based data form randomized controlled trials are very limited. This review shows an overview of the current understanding of the pathogenesis, comorbidities, differential diagnosis, treatment and prevention of pediatric psoriasis, also presenting with an emphasis on the necessity of an integrated treatment approach involving different specialists such as dermatologist, pediatricians, rheumatologists, etc.
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- "It must be noted at this point that all biologics have a considerable financial cost for the insurance covering the patient’s treatment, and this is an issue that must be taken into account when one prescribes these drugs. In the absence of official guidelines for the laboratory monitoring of children on therapy with biologics for psoriasis, they should undergo the baseline screening along with the treatment monitoring that is applied to adult patients.55 Baseline screening includes the Mantoux test or interferon-γ-release assays for tuberculosis, a chest X-ray, immunization updates, tests for hepatitis B and C and human immunodeficiency virus, and hematology and biochemical examinations that also include liver-function tests. "
ABSTRACT: Psoriasis is a chronic inflammatory cutaneous disorder affecting 2%-4% of the world's population. The prevalence of the disease in childhood and adolescence ranges between 0.5% and 2%. The management of psoriasis in adolescence is an intriguing and complicated task. Given the paucity of officially approved therapies, the very limited evidence-based data from randomized controlled trials, and the absence of standardized guidelines, physicians must rely on published experience from case reports both from the field of dermatology as well as from the application of these drugs for other pediatric conditions coming from the disciplines of rheumatology, gastroenterology, and oncology. Psoriatic adolescents deal with a potentially disfiguring and lifelong disease that could permanently impair their psychological development. It must be clarified to them that psoriasis does not have a permanent cure, and therefore the main goal of treatments is to establish disease control and prolonged periods between flares. The majority of adolescents suffer from mild psoriasis, and thus they are treated basically with topical treatment modalities. Phototherapy is reserved for adolescents with mild-to-moderate plaque disease and/or guttate psoriasis when routine visits to specialized centers do not create practical problems. Systemic agents and biologics are administered to patients with moderate-to-severe plaque psoriasis, pustular psoriasis, or erythrodermic psoriasis.
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ABSTRACT: Psoriasis is a chronic, inflammatory, immune-mediated skin disease that affects roughly 2% of adults in the United States. The immunopathogenic pathways associated with psoriasis are complex, and to effectively target the underlying cytokine networks involved in disease progression, drugs are needed that act on specific components of the immune system. As understanding of the role of proinflammatory signaling molecules in the psoriatic disease process has evolved, several biologic agents have been engineered to block key cytokines associated with psoriasis. Recently, improvements in the understanding of the pathogenesis have led to the development of agents that may target the mechanism of disease more directly. This review describes the immunopathogenesis of psoriasis and how targeting disease-specific mechanisms with biologic agents may improve clinical outcomes and potentially result in better safety profiles than conventional agents. Results from pivotal clinical studies evaluating the efficacy and safety of approved tumor necrosis factor-α antagonists (etanercept, infliximab, and adalimumab) and the interleukin-12/23 inhibitor ustekinumab are summarized. In addition, we include clinical findings to date evaluating a new class of biologics that neutralize interleukin-17A (secukinumab, ixekizumab) or act as an interleukin-17 receptor antagonist (brodalumab). Finally, this review discusses efficacy and safety factors, as well as patient characteristics to consider, when selecting a biologic agent for psoriasis disease management.
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