Biologics have emerged as an exciting new therapy for the treatment of psoriasis and psoriatic arthritis. Currently, four biologics are approved by the U.S. Food and Drug Administration (FDA) for the treatment of moderate to severe psoriasis, including alefacept (Amevive), efalizumab (Raptiva), etanercept (Enbrel) and infliximab (Remicade). A fifth, adalimumab (Humira), is being studied in late-stage clinical trials. The use of biologics in patients with psoriasis and concurrent co-morbidities has not been extensively studied. Because several of the biologics have been used for many years to treat other immune-mediated diseases such as rheumatoid arthritis and Crohn's disease, more data exist on their use in these patients with co-morbidities. Here, we review the literature and offer our opinions on the appropriate use of alefacept, efalizumab, etanercept, infliximab and adalimumab in patients with psoriasis and specific co-morbidities, including multiple sclerosis, tuberculosis, heart failure, cancer, hepatitis C, HIV and renal failure.
Get full access to this article
View all access options for this article.
References
1.
AkassoglouK., ProbertL., KontogeorgosG., KolliasG.Astrocyte-specific but not neuron-specific transmembrane TNF triggers inflammation and degeneration in the central nervous system of transgenic mice. J Immunol.1997; 158: 438–45.
2.
KolliasG., DouniE., KassiotisG., KontoyiannisD.The function of tumor necrosis factor and receptors in models of multi-organ inflammation, rheumatoid arthritis, multiple sclerosis and inflammatory bowel disease. Ann Rheum Dis.1999; 58(suppl 1): 132–139.
3.
The Lenercept Multiple Sclerosis study group, and The University of British Columbia MS/MRI Analysis Group. TNF neutralization in MS: results of a randomized, placebo-controlled multicenter study. Neurology.1999; 53: 457–465.
4.
MohanN., EdwardsE.T., CuppsT.R., OliverioP.J., SandbergG., CraytonH.Demyelination occurring during anti-tumor necrosis factor alpha therapy for inflammatory arthritides. Arthritis Rheum.2001; 44: 2862–2869.
5.
SicotteN.L., VoskuhlR.R.Onset of multiple sclerosis associated with anti-TNF therapy. Neurology.2001; 57: 1885–1888.
6.
SukalS.A., NadimintiL., GransteinR.D.Etanercept and demyelinating disease in a patient with psoriasis. J Am Acad Dermatol.2006; 54: 160–164.
7.
CisternasM., GutierrezM., JacobelliS.Successful rechallenge with anti-tumor necrosis factor-α for psoriatic arthritis after development of demyelinating nervous system disease during initial treatment: comment on the article by Mohan, et al. Arthritis Rheum.2002; 46: 3107–8.
8.
ThomasC.W., WeinshenkerB.G., SandbornW.J.Demyelination during anti-tumor necrosis factor alpha therapy with infliximab for Crohn's disease. Inflamm Bowel Dis.2004; 10: 28–31.
EnayatiP.J., PapadakisK.A.Association of anti-tumor necrosis factor therapy with the development of multiple sclerosis. J Clin Gastroenterol.2005; 39: 303–306.
11.
ShinI.J., BaerA.N., KwonH.J.Guillain-Barre and Miller Fisher syndromes occurring with tumor necrosis factor-α antagonist therapy. Arthritis Rheum.2006; 54: 1429–1434.
12.
GuptaG., GelfandJ.M., LewisJ.D.Increased risk for demyelinating diseases in patients with inflammatory bowel disease. Gastroenterology.2005; 129: 819–826.
13.
EhlersS.Tumor necrosis factor and its blockade in granulomatous infections: differential modes of action of infliximab and etanercept?Clin Infec Dis.2005; 41: S199–203.
GardamM.A., KeystoneE.C., MenziesR., MannersS., SkameneE., LongR., VihnD.C.Anti-tumor necrosis factor agents and tuberculosis risk: mechanisms of action and clinical management. Lancet Infect Dis.2003; 3: 148–55.
17.
Centers for Disease Control, and Prevention. Tuberculosis associated with blocking agents against tumor necrosis factor-alpha - California, 2002–2003. MMWR Morb Mortal Wkly Rep.2004; 53: 683–6.
18.
TaylorJ.C., OrkinR., LanhamJ.Tuberculosis following therapy with infliximab may be refractory to antibiotic therapy. Rheumatology.2003; 42: 901–902.
19.
RuizJ.P., CentenoN.O., AlvarezE.R.Development of tuberculosis in a patient treated with infliximab who had received prophylactic therapy with isoniazid. J Rheum.2003; 30: 1657–8.
20.
RouthouskaS.B., KormanN.J.Initiating and monitoring patients on biologic therapy for psoriasis beyond the FDA: our more cautious approach. Psoriasis Forum.2006; 12: 12–15.
21.
LevineB., KalmanJ., MayerL., FillitH.M., PackerM.Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N Engl J Med.1990; 323: 236–41.
22.
Sarzi-PuttiniP., AtzeniF., ShoenfeldY., FerroccioliG.TNF-α, rheumatoid arthritis, and heart failure: a rheumatological dilemma. Autoimmun Rev.2005; 4: 153–161.
23.
MannD.L., McMurrayJ.J., PackerM., SwedbergK., BorerJ.S., ColucciW.S.Targeted anticytokine therapy in patients with chronic heart failure: results of the randomized etanercept worldwide evaluation (RENEWEL). Circulation.2004; 109: 1594–1602.
24.
ChungE.S., PackerM., LoK.H., FasanmadeA.A., WillersonJ.T.Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-α, in patients with moderate-to-severe heart failure. Circulation.2003; 107: 3133–3140.
25.
KwonH.J., CoteT.R., CuffeM.S., KramerJ.M., BraunM.M.Case reports of heart failure after therapy with a tumor necrosis factor antagonist. Ann Intern Med.2003; 138: 807–811.
26.
WolfeF., MichaudK.Heart failure in rheumatoid arthritis: rates, predictors, and the effect of tumor necrosis factor therapy. Am J Med.2004; 116: 305–311.
27.
KhannaD., McMahonM., FurstD.E.Anti-tumor necrosis factor a therapy and heart failure: what have we learned and where do we go from here?Arthritis Rheum.2004; 50: 1040–1050.
28.
GelfandJ.M., NeimannA.L., ShinD.B., WangX., MargolisD.J., TroxelA.B.Risk of myocardial infarction in patients with psoriasis. JAMA.2006 Oct 11; 296(14): 1735–41.
29.
EkstromK., HjalgrimH., BrandtL., BaecklundE., KlareskogL., EkbomA.Risk of malignant lymphomas in patients with rheumatoid arthritis and in their first-degree relatives. Arthritis Rheum.2003; 48: 963–70.
30.
GelfandJ.M., BerlinJ., van VoorheesA., MargolisD.J.Lymphoma rates are low but increased in patients with psoriasis: results from a population-based cohort study in the United Kingdom. Arch Dermatol.2003; 139: 1425–9.
31.
BaecklundE., EkbomA., SparenP., FelteliusN., KlareskogL.Disease activity and risk of lymphoma in patients with rheumatoid arthritis: nested case-control study. BMJ.1998; 317: 180–1.
32.
BernsteinC.N., BlanchardJ.F., KliewerE., WajdaW.Cancer risk in patients with inflammatory bowel disease: a population-based study. Cancer.2001; 91: 854–62.
33.
AsklingJ., BrandtL., LapidusA., KarlenP., BjorkholmM., LofbergR.Risk of haematopoietic cancer in patients with inflammatory bowel disease. Gut.2005; 54: 617–622.
34.
LewisJ.D., BilkerW.B., BrensingerC., DerenJ., VaughnD.J., StromB.L.Inflammatory bowel disease is not associated with an increased risk of lymphoma. Gastroenterology.2001; 121: 1080–1087.
35.
BrownS.L., GreeneM.H., GershonS.K., EdwardsE.T., BraunM.M.Tumor necrosis factor antagonist therapy and lymphoma development: twenty-six cases reported to the Food and Drug Administration. Arthritis Rheum.2002; 46: 3151–3158.
36.
WolfeF., MichaudK.Lymphoma in rheumatoid arthritis. Arthritis Rheum.2004; 50: 1740–1751.
37.
LjungT., KarlenP., SchmidtD., HellstromP.M., LapidusA., JanczewskaI.Infliximab in inflammatory bowel disease: clinical outcome in a population based cohort from Stockholm County. Gut.2004; 53: 780–2.
38.
AdamsA.E., ZwickerJ., CurielC., KadinM.E., FalchukK.R., DrewsR.Aggressive cutaneous T-cell lymphomas after TNF-α blockade. J Am Acad Dermatol.2004; 51: 660–2.
39.
Wegener's Granulomatosis Etanercept Trial (WGET) Research Group. Etanercept plus standard therapy for Wegener's granulomatosis. N Engl J Med.2005; 352: 351–61.
40.
KnightA., AsklingJ., EkbomA.Cancer incidence in a population-based cohort of patients with Wegener's granulomatosis. Int J Cancer.2002; 100: 82–85.
SmithK.J., SkeltonH.G.Rapid onset of cutaneous squamous cell carcinoma in patients with rheumatoid arthritis after starting tumor necrosis factor alpha IgGi-Fc fusion complex therapy. J Am Acad Dermatol.2001; 45: 953–6.
43.
LebwohlM., BlumR., BerkowitxE., KimD., ZitnikR., OsteenC.No evidence for increased risk of cutaneous squamous cell carcinoma in patients with rheumatoid arthritis receiving etanercept for up to 5 years. Arch Dermatol.2005; 141: 861–864.
44.
AlcainG., AndradeR.J., Queipo de LlanoM.P., MorenoM.J., Garcia-CortesM., FranqueloE.Acute leukemia after infliximab therapy. Am J Gastroenterol.2003; 98: 2577.
45.
EsserA.C., AbrilA., FayneS., DoyleJ.A.Acute development of multiple keratoacanthomas and squamous cell carcinomas after treatment with infliximab. J Am Acad Dermatol.2004; 50: S75–7.
46.
ThayuM., MarkowitzJ.E., MamulaP., RussoP.A., MuinosWl, BaldassonaR.N.Hepatosplenic T-cell lymphoma in an adolescent patient after immunomodulator and biologic therapy for Crohn disease. J Pediatric Gastroenterol Nutr.2005; 40: 220–2.
47.
Centocor, Infliximab package insert. May 2006
48.
MorseL.G., YarbroughL., HoganD.J.Cervical cancer in a woman associated with long-term efalizumab therapy. J Am Acad Dermatol.2005; 53: 354–5.
49.
BongartzT., SuttonA.J., SweetingM.J., BuchanI., MattesonE.L., MontoriV.Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies. JAMA.2006; 295: 2275–2285.
50.
ZylberbergH., RimaniolA.C., PolS., MassonA., De GrooteD., BerthelotP.Soluble tumor necrosis factor receptors in chronic hepatitis C: a correlation with histological fibrosis and activity. J Hepatol.1999; 30: 185–91.
51.
ZeinN.N.Etanercept as an adjuvant to interferon and ribavirin in treatment-naïve patients with chronic hepatitis C virus infection: a phase 2 randomized, double-blind, placebo-controlled study. J Hepatol.2005; 42: 315–322.
52.
PetersonJ.R., HsuF.C., SimkinP.A., WenerM.H.Effect of tumour necrosis factor-α antagonists on serum transaminases and viraeimia in patients with rheumatoid arthritis and chronic hepatitis C infection. Ann Rheum Dis.2003; 62: 1078–1082.
53.
ParkeF.A., ReveilleJ.D.Anti-tumor necrosis factor agents for rheumatoid arthritis in the setting of chronic hepatitis C infection. Arthritis Rheum.2004; 51: 800–804.
54.
CampbellS., GhoshInfliximab therapy for Crohn's disease in the presence of chronic hepatitis C infection. Eur J Gastroenterol Hepatol.2001; 13: 191–192.
55.
HoltmannM.H., GalleP.R., NeurathM.F.Treatment of patients with Crohn's disease and concomitant chronic hepatitis C with a chimeric monoclonal antibody to TNF. AJG.2003; 98: 504–505.
56.
KhannaM., ShirodkarM.A., GottliebA.B.Etanercept therapy in patients with autoimmunity and hepatitis C. J Dermatol Treat.2003; 14: 229–232.
57.
MaglioccoM.A., GottliebA.B.Etanercept therapy for patients with psoriatic arthritis and concurrent hepatitis C virus infection: report of 3 cases. J Am Acad Dermatol.2004; 51: 580–4.
58.
RokhsarC., RabhanN., CohenS.R.Etanercept monotherapy for a patient with psoriasis, psoriatic arthritis, and concomitant hepatitis C infection. J Am Acad Dermatol.2006; 54: 361–362.
59.
De SimoneC., ParadisiA., CapizziR., CarboneA., SicilianoM., AmerioP.L.Etanercept therapy in two patients with psoriasis and concomitant hepatitis C. J Am Acad Dermatol.2006; 54: 1102–1104.
60.
MarotteH., FontangesE., BaillyF., ZoulimF., TrepoC., MiossecP.Etanercept treatment for three months is safe in patients with rheumatological manifestations associated with hepatitis C virus. Rheumatology (Oxford)2006; Rheumatology advance access published online on May 23,3006.
61.
ThaçiD., PätzoldS., KaufmannR., BoehnckeW.H.Treatment of psoriasis with alefacept in patients with hepatitis C infection: a report of two cases. Br J Dermatol.2005; 152: 1048–1050.
62.
MallonE., BunkerC.B.HIV-associated psoriasis. AIDS Patient Care STDS2000; 14: 239–46.
63.
BartkeU., VentenI., KreuterA., GabbayS., AltmeyerP., BrockmeyerN.H.Human immunodeficiency virus-associated psoriasis and psoriatic arthritis treated with infliximab. Br. J Dermatol.2004; 150: 784–6.
64.
GaylisN.Infliximab in the treatment of an HIV positive patient with Reiter's syndrome. J Rheumatol.2003; 30: 407–411.
65.
AbouflaD.M., BundowD., WilskeK., OchsI.Etanercept for treatment of human immunodeficiency virus-associated psoriatic arthritis. Mayo Clin Proc.2000; 75: 1093–8.
66.
WallisR.S., KyambaddeP., JohnsonJ.L., HorterL., KittleR., PohleM.A study of the safety, immunology, virology, and microbiology of adjunctive etanercept in HIV-1-associated tuberculosis. AIDS.2004; 18: 257–264.
67.
DonB.R., SpinG., NestorovI., HutmacherM., AubriRose, KaysenG.The pharmacokinetics of etanercept in patients with end-stage renal disease on haemodialysis. J Pharm and Pharmacology.2005; 57: 1407–1413.
68.
SinghR., CuchacovichR., HueangW., EspinozaL.R.Infliximab treatment in a patient with rheumatoid arthritis on hemodialysis. J Rheumatol.2002; 29: 636–7.
69.
HammoudehM.Infliximab treatment in a patient with rheumatoid arthritis on haemodialysis. Rheumatology. (Oxford)2006; 45: 357–9.
