Psoriasis treatments Flashcards
Learn drug names and dosage
What is the structure of Etanercept (Enbrel )?
Need to check from what age is it approved in children
Fusion protein consisting of the extracellular domain of two p75 TNF receptor fused with the Fc portion of human IgG1.
In the Bolognia text pg 2247 approved for children ages 4-17.
What is the approved dosage for moderate to severe plaque type psoriasis ?
Children dosage ?
Subcutaneously 50mg twice weekly for the first 3 months, followed by 50 mg weekly.
For children: 0.8 mg/ kg ( maximum 50 mg ) weekly.
What are cutaneous side effects of Tumor Necrosis factor inhibitors :
1) New onset psoriasis, especially palmoplantar pustulosis.
2) interstitial granulomatous dermatitis and other granulomatous eruptions.
3) cutaneous small vessel vasculitis
4) eczematous eruptions
5) Lichenoid dermatitis
6) Lupus-like syndrome associated malar rash or discoid lesions.
7) Other types of cutaneous lupus, e.g. SCLE, chilblain lupus.
Infliximab ( Remicade ) is ..,
Chimeric human-mouse monoclonal IgG1 antibody that target human TNF.
For Sarcoidosis , which TNF inhibitors is effectivevand which one is not ?
Effective : Infliximab -Remicade Not effective ( failed to improve systemic manifestations of sarcoudosis in randomized controlled trials) : Enbrel.
What cutaneoys diseases were treated with Infliximab effectively ?
Pyoderma gangrenosum ( whether or not it is associated with IBD)
- Sarcoidosis
- Granulomatous cheilitis
- Behcet disease
- various vasculitidew
- PRP
- reactive arthritis
- subcorneal pustular dermatosis
- GVHD
- Sjogren syndrome
- multicentric reticulohistyocytosis
- Hidradenitis suppurativa
Infliximab regimen for psoriasis is :
5 mg/ kg administered by slow IV infusion
At
0 , 2 weeks , 6 weeks
And then every 8 weeks.
However, doses ranging from 3-10 mg/kg have been utilized.
Frequency and dose can be adjusted when the response is inadequate.
Loss of efficacy of Infliximab over time is related to :
Development of neutralizing anti-chimeric antibodies and has been associated with the presence of ANA.
The concurrent administration of low-dose weekly methotrexate may help to prevent the formation of anti-chimeric antibodies.
How to reduce risk of Influximab infusion reactions ( which has been linked to presence of human antichemeric antibodies )
Slower infusion rate
Concomitant use of methotrexate , azathiopribe , or corticosteroids.
Adalimumab is
Human recombinant IgG1 monoclonal antibodies with specificity for human TNF
Adalimumab dosage for psoriasis :
Subcutaneous
Initial loading dose : 80 mg
Day 8 : 40 mg
Then 40 mg every other week.
Adalimumab benefits for hidradenitis suppurativa
Approved for HS
40-60% of patients achieving a 50% reduction in the abscess/inflammatory nodule count with no increase in the draining fistula count.
Adalimumab dosage for HS
Loading dose : 160 mg
Day 15 : 80 mg
Day 29 and on : 40 mg weekly
Stelara is … works by…
Ustekinumab is a human IgG1 monoclonal antibody that targets IL-12 and IL-23.
It binds with high affinity and specificity to the p40 subunit that is shared by the heterodimeric IL-12 and IL-23 cytokines.
IL -12 has a critical role in the development of TH1 cells and NK cell activation.
IL-23 is necessary for the generation of Th17 cells.
Guselkuman ( Tremfya) , Risankizumab ( Skyrizi) and tildrakizumab target…
The p19 subunit of IL-23.
Stelara dosage
Subcutaneous injection
For <100 KG : 45 MG
FOR > 100 Kg : 90 MG
Weeks 0, 4 weeks and then every 12 weeks.
Guselkumab ( Tremfya ) dosage
Subcutaaneous injection
100 mg
At 0, week 4, and then every 8 weeks.
Ustekinumab side effects
Increases incidence of mucocutaneous candidiasis ( %5 of patients )
A potential risk of severe and disseminated infections with mycobacteria and Salmonella.
Cardiovascular : individual trials showed possible excess risk of major adverse cardiovascular events but meta analyses and 5 year followuo did not find an increased risk
Could ptentially increase the risk of malignancies.
Should be avoided in patients with serious active infections or malignancies.
Name IL-17 inhibitors
Ixekizumab - Taltz - humanized IgG4 monoclonal antibody that binds and inhibits IL-17A, resulting in neutralization of IL17A homodimers and IL-17A/F heterodimers.
Secukinumab -Cosentyx - a human IgG1k monoclonal antibody that binds with high affinity and selectiveky to IL-17A
Brodalumab - Siliq - human IgG2k monoclinal antibody that selectively binds the IL-17 receptor A, inhibiting its interactions with IL17A/F and IL-17E.
Contraindications for IL-17 inhibitors
Caution in patients with chronic /recurrent infections or inflammatory bowel disease
Crohn disease representing a CI for brodalumab.
Avoided or discontinued in patients with a serious active infection.
Side effects 9f IL-17 inhibitors are :
Most common :
Nasopharyngitis
Upper respiratory tract infections
Injection site reaction
Others:
** Hypersensitivity reactions including anaphylaxis, angioedema, and urticaria.
** Mucocutaneous candidiasis ( mild to moderate) ,most often oral or vulvovaginal, develops in ~5% of patients. ( reflects the important role of IL-17 in defense againat Candida.
**Neutropenia: <1500 cells/mm3 occurs in 1-2% of patients ( similar ro Etanercept)
** New onset and excacerbation of Crohn disease and ulcerative colitis.
NOT observed : increased risk of advwrse cardiovascular events in clinical trials.
Ixekizumab dosage regimen is
Loading dose of 160 mh
80 mg every 2 weeks for 12 weeks
80 mg every 4 weeks.
Secukinumab -Cosentyx dosage
Subcutaneous injection of
300mg at weeks 0, 1, 2, 3, and 4 and thereafter it is given every 4 weeks.
A dose of 150 mg may be considered for patients weighing < 90 kg.
Brodalumab indication and dosage
Mod to severe psoriasis in adults who have failed or become unresponsive to other systemuc therapies.
Subcutaneous 210 mg every 2 weeks.
It is contraindicated in Crohn disease and suicidal ideation as well as suicides occured during clinical trials.!!!!!
