Research, clinical experience drive biologic choices

As research and clinical experience continue to clarify biologic drugs' roles, the key to successful treatment remains educating and involving patients in treatment decisions, experts say.

"For many patients," says Jeffrey M. Weinberg, M.D., "the use of biologics has liberated them from their disease." He is assistant clinical professor of dermatology at Columbia University and director of the Clinical Research Center at St. Luke's-Roosevelt Hospital Center, New York.

BIOLOGIC MONOTHERAPY?

But overall, Dr. Weinberg says, "My philosophy has been that one wants to achieve biologic monotherapy in moderate-to-severe cases." If this proves impossible, he says one should consider adding topical therapies or phototherapy.

In particular, Dr. Weinberg reveals, "I have found Taclonex ointment (calcipotriene-betamethasone dipropionate, Leo Pharma/Warner Chilcott) very useful" for patients whose disease doesn't fully clear with biologics alone.

Conversely, he says biologics don't work for all patients. Therefore, Dr. Weinberg says, "The most important element with biologics is patient education. It's very important to set the expectation for patients that we don't know how to predict response or failure" of a given biologic treatment presently, and that patients might have to try a few drugs to find the right one for them.

PATIENT PARTICIPATION

Once one has narrowed down the patient's safest and most effective options, Dr. Weinberg adds, "One must talk about all the pros and cons of these different drugs. Let the patient be part of the decision."

Similarly, he says one should encourage patients to join the National Psoriasis Foundation. Dr. Weinberg advises colleagues to, "Impress upon patients that it's important to get their information from a reliable source, and the (National) Psoriasis Foundation certainly is reliable."

In any population, Dr. Weinberg adds, "Alefacept is going to work for the fewest people. In terms of pure efficacy, Remicade (infliximab, Centocor) and Humira (adalimumab, Abbott) give one the highest number of patients reaching a desired endpoint such as Psoriasis Area and Severity Index (PASI) 75." The performance of efalizumab (Raptiva, Genentech) and etanercept (Enbrel, Amgen/Wyeth) falls somewhere between the two extremes, he adds. One also must consider that infliximab and adalimumab presently are not Food and Drug Administration-approved for plaque psoriasis, Dr. Weinberg says.

Disclosure: Dr. Weinberg has served on speakers' bureaus and received research grants from Abbott, Genentech and Amgen.

For more information: http://www.psoriasis.org/