Biologics

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Each biologic is characterised below according to the alphabetical order of the name of the active substance. Only 3 of 4 available biologic therapies can be delivered under a drug program for severe plaque psoriasis: adalimumab, ustekinumab, and etanercept.

Adalimumab

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A recombinant human monoclonal antibody specific for human necrosis factor alpha, TNF-α. It is a powerful anti-inflammatory agent. Adalimumab is administered by subcutaneous injection. It binds specifically to TNF and neutralises its biological activity by blocking interaction with receptors on the cell surface.

The most common side-effects of Adalimumab are infections (sinusitis, respiratory tract infections), headaches, musculoskeletal pain, and injection site reactions. Like any other anti-TNF antagonist, Adalimumab can also be used in the management of Crohn's disease, rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis involving multiple joints, ankylosing spondylitis (AS), axial spondyloarthropathy, and non-radiographic axial spondyloarthropathy;

For more information please refer to the summary of the European public assessment report (EPAR)

Etanercept

Etanercept is a recombinant human tumor necrosis factor receptor (p75) Fc fusion protein. Fusion protein can recognise and bind specifically to antigens present in the body to block the activity of TNF-α. Due to its anti-inflammatory properties, the inflammation extent is progressively reduced. Etanercept is used in plaque psoriasis, rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, and ankylosing spondylitis. The most common side-effects of etanercept are: injection site reaction (i.e.erythema, itching) and infections (common cold, pneumonia).

For more information please refer to the summary of the European public assessment report (EPAR)

Infliximab

Infliximab is a chimeric anti-tumour necrosis factor alpha (TNF-α) monoclonal antibody. It is administered by intravenous infusion. Infliximab is used in psoriasis, rheumatoid arthritis, Crohn's disease, ulcerative colitis, ankylosing spondylitis, and psoriatic arthritis. Infliximab is an anti-inflammatory drug. The most common side-effects of infliximab include reactions to intravenous infusion: dyspnoea (shortness of breath), urticaria, as well as viral infections, infections of the lower and upper respiratory tract, and indigestion.

For more information please refer to the summary of the European public assessment report (EPAR)

Ustekinumab

It is a monoclonal antibody that binds specifically to two types of proteins involved in processes that cause psoriasis. By blocking their activity, Ustekinumab reduces the activity of the immune system. In consequence, the inflammatory condition and the symptoms of the disease are reduced. Ustekinumab is used in moderate and severe psoriasis and in psoriatic arthritis. It is administered by subcutaneous injection. The most common side-effects of Ustekinumab are: headaches, upper respiratory track infections, and inflammations of the nasal and pharyngeal mucosa.

For more information please refer to the summary of the European public assessment report (EPAR)

Barriers to the introduction of biologic therapies

Biologics used in the treatment of psoriasis are highly effective but very expensive, and cost is perhaps the main barrier to the widespread use of this type of agent. Eligibility criteria for biologic therapy include moderate to severe psoriasis vulgaris and failure of previous therapies. To make biologic therapies more readily available, dedicated therapeutic programs have been established.
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