Biologics for Psoriasis Have Wide Variation in Price, Ease of Use

Peggy Peck

February 22, 2005

Feb. 22, 2005 (New Orleans) — Any one of five biologic agents can be "the best choice for an individual patient with plaque psoriasis," but there is about a $15,000 range from low to high annual cost associated with the agents. In addition, all of the drugs carry risk for serious adverse events including tuberculosis and liver failure, according to William Abramovits, MD, professor of dermatology at Baylor University Medical Center in Dallas, Texas.

Dr. Abramovits presented results from a comparison of adalimumab, alefacept, efalizumab, etanercept, and infliximab at a poster discussion session here at the 63rd annual meeting of the American Academy of Dermatology.

He told Medscape that he keeps the compiled data "on a chart in my office so that I discuss the risks and benefits of each treatment with the patient." Patients often ask "which drug is best for me? But the answer is not simple. For example, a patient that doesn't have insurance or one with insurance that provides only minimal coverage may want to consider adalimumab or efalizumab, each of which cost about $20,000, rather than a drug like alefacept or infliximab, both of which are more expensive," Dr. Abramovits said.

In the comparison study, which was self-funded by Dr. Abramovits in order to "be completely independent," alefacept was both the most expensive drug ($35,565 annually) and was also among the most inconvenient agents because it requires weekly laboratory work and office visits for intramuscular (IM) administration. The average wholesale price for each 15-mg vial of alefacept is $995 (28 vials are needed for a year's treatment, so the drug cost alone is $27,860; he added another $7,705 to cover office visits, IM injection fees, baseline laboratory tests, as well as follow-up tests).

By comparison, a 40-mg syringe of adalimumab has an average wholesale price of $653, and 26 syringes are needed for a year's treatment, which works out to $16,978 per year. Less than $2,000 is added to that to cover office visits and laboratory tests for a total average wholesale price of $18,743.

Dr. Abramowits said he used "data from phase 3 trials as well as nonregistry published trials of the drugs" for his study. In addition, "I contacted the medical directors at each company to explain what I was doing and to verify that I had included the correct information." He said the medical directors "were very helpful and very cooperative."

"This is fabulous. I wish I could download this information into my brain," said Phoebe Rich, MD, clinical associate professor of dermatology at Oregon Health Sciences University in Portland. Dr. Rich moderated the poster session at which the data were presented. "It is especially impressive because it is independent," she said. "Much of the information that we get from drug companies can be confusing, so it is really helpful to have this laid out in a simple format."

Dr. Abramovits' breakdown of the benefits and disadvantages for the five drugs were:


Administration and Benefits



Self-administration (subcutaneous) every other week or weekly. Fully human antibody. Very good and fast response (one week).

Black box warning: Tuberculosis risk


Lowest percentage of antibody development. Remitative — in responders, duration of response is seven months.

Inconvenient weekly lab work and office visits for IM administration. Cost. Hepatotoxicity.


Self-administration (subcutaneous). Speed of onset (two to four weeks).

Firstdose injection site reaction. Risk of flare during treatment and at treatment interruption. Possible thrombocytopenia risk.


Self-administration (subcutaneous). Good response.

Tuberculosis risk, possible congestive heart failure, demyelinating disorders risks.


Excellent responses. Speed of onset (two to three weeks). Least frequently dosed.

Black box warning: Risk of tuberculosis, other infections. Intravenous infusion. Neutralizing antibodies lead to dose escalation. Possible congestive heart failure risk as well as demyelinating disorders, hepatotoxicity.

Dr. Abromavits said, however, that he "does not favor one biologic over another. The important issue is to match the patient to the agent that is best for that particular patient."

AAD 63rd Annual Meeting: Poster 2. Presented Feb. 19, 2005.

Reviewed by Gary D. Vogin, MD


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