American academy of dermatology, summer academy meeting.
نویسندگان
چکیده
inhibit progression of joint destruction. He said that TNF inhibitors are unique in their ability to do that but added that uste kinumab is unproven in PsA. Although one pilot study indicated a degree of response,1 “the jury is still out,” he claimed. In his own experience, he said that ustekinumab did not perform as well as the TNF blockers—or methotrexate— against PsA. Regarding cardiovascular risk, one study showed that TNF inhibitors could increase amounts of the protective cytokine adiponectin.2 Similarly, in a retrospective analysis of patients with psoriasis, TNF inhibitor therapy corresponded with a decreased risk of myocardial infarction (MI).3 Conversely, Dr. Strober said that a meta-analysis he co authored suggests that the interleukin (IL)-12 and IL-23 inhibitors ustekinumab and Abbott’s briakinumab (ABT 874) showed a small numerical imbalance, indicating a possible risk for a major adverse cardiovascular event (AE), namely stroke, MI, or sudden cardiac death.4 “The TNF inhibitors do not appear to carry this risk,” he said. Because of the potential for cardiovascular AEs, he said that Abbott has withdrawn its application for the FDA’s approval of briakinumab. He said, “The issue arises now whether ustekinumab poses a very small yet real risk to certain patients—we cannot yet define who they are—of major adverse cardiovascular events, especially in the first six months of therapy.” Because ustekinumab might carry a risk that TNF inhibitors don’t, “it may mean that we want to use TNF inhibitors before ustekinumab unless there’s a contraindication to using a TNF blocker,” he said. Another factor that guides the choice of a biologic therapy is efficacy. In this regard, said Dr. Strober, the proportions of patients who show 75% improvement in Psoriasis Area and Severity Index scores (PASI 75) with infliximab, adalimumab or ustekinumab, etanercept, and alefacept are 80%, 70%, 50%, and 25%, respectively. Moreover, he said that physicians also must recognize that patients tend to lose their response to all of these drugs over the long term, which may necessitate switching them to another biologic agent. As for ease of use, Dr. Strober pointed out that patients require subcutaneous injections of etanercept, adalimumab, and uste kinumab, performed weekly, every other week, or every 12 weeks, respectively. Conversely, the intravenous infusion required for infliximab and the intramuscular injections needed for alefacept often prove difficult for patients. Regarding the FDA’s warning in September about a risk of Legionella and Listeria infections for patients taking TNF inhibitors, he said: “I don’t believe it changes anything. When you’re monitoring patients on TNF inhibitors, you’re always thinking about infection risk. This warning [was] just added to the list of possible pathogens.” TNF Inhibitors a Top Choice Among Biologics For Psoriasis • Bruce E. Strober, MD, PhD, Assistant Professor of Dermatology and Director of Clinical Trials, University of Connecticut, Farmington, Conn.
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عنوان ژورنال:
- P & T : a peer-reviewed journal for formulary management
دوره 36 11 شماره
صفحات -
تاریخ انتشار 2011