What are the British Association of Dermatologists recommended biologic agents for the treatment of psoriasis?

Updated: Nov 20, 2020
  • Author: Jacquiline Habashy, DO, MSc; Chief Editor: William D James, MD  more...
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Answer

In adults, offer any of the currently approved biologic therapies as first‐line therapy, substituting a different approved biologic should the first one fail. Tumor necrosis factor (TNF) antagonists or interleukin 17 antagonists should be offered as first-line therapy for patients with psoriatic arthritis. Etanercept can be considered in TNF antagonist–eligible patients if other biologics have failed or cannot be used, or if a short half‐life is important. Infliximab should be reserved for very severe disease or if age-based dosing is important, or if other biologics have failed or cannot be used.

For pediatric patients, adalimumab can be offered for patients aged 4 years or older, etanercept for patients aged 6 years or older, or ustekinumab for those aged 12 years or older, if they meet the criteria for biologic therapy. If these agents do not provide an adequate response, a specialist in pediatric biologic therapy should be consulted, along with consideration of the following:

  • Advice about factors that may be contributing to the poor response, such as obesity and poor compliance
  • Optimization of adjunctive therapy, such as switching from oral to subcutaneous methotrexate
  • Supplementary or alternative nonbiologic therapies, such as inpatient topical therapy or systemic therapies

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