SATURDAY

November 8

RAPID FIRE
LUNCH

11:45 – 1:30

THE ROLE OF THE BIOLOGICS FOR THE TREATMENT OF PSORIASIS

Chuck Lynde

Psoriatics with moderate to severe disease represent a population with significant limitations with the traditional therapies. While some systemic treatments are effective in the short term, their side-effect profiles prohibit long-term treatment of this chronic disease. Other therapies require frequent, complicated treatment schedules and access to specialized equipment located in the physician’s office.

In recent years, our increased understanding of the role of immunology in the pathophysiology of psoriasis has led to the development of biologic therapies designed to interfere with the underlying molecular mechanisms at play in the disease. The central role of the T cells in the pathogenesis of psoriasis is now well recognized, and many of the biologic agents in development target specific T-cell-mediated steps that are known to be associated with the psoriatic phenotype.

These include agents that interfere with the interaction between the reactivated T cells and the keratinocytes in the dermis by binding postsecretory cytokine tumor necrosis factor-a (infliximab and entercept); those that decrease the number of activated T cells (alefacept); and those that block T-cell activation, binding, and trafficking to the dermis and epidermis (efalizumab). Of these agents, alefacept was approved by the United States Food and Drug Administration (FDA) in January 2003 for the treatment of psoriasis. Etanercept is approved for use in juvenile rheumatoid arthritis, psoriatic arthritis, and rheumatoid arthritis; and infliximab is approved for the use in rheumatoid arthritis and Crohn’s disease. Both etanercept and infliximab are in phase III trials for the treatment of psoriasis. Eflaizumab has just been given initial FDA approval. Each of these new biological agents offers new hope for many psoriatics.

It is important that dermatologists become well educated in biologics, since many biologic agents are in the late stages of clinical testing, and will soon become available for the treatment of psoriasis. These will become widely used, and become the standard of practice.