British Association of Dermatologists guidelines for use of biological interventions in psoriasis 2005

Abstract

Psoriasis is a common, persistent, relapsing inflammatory
\nskin disease that can be associated with significant morbidity.
\nQuality of life studies in psoriasis reveal a negative
\nimpact on patients comparable with that seen in cancer,
\narthritis and heart disease.1–5 Patients with severe disease
\nconstitute approximately 20–30% of all patients with psoriasis,
\noften require systemic treatment, and represent a major
\neconomic burden to the Health Service.
\nAll standard systemic therapies for severe disease are associated
\nwith the potential for major long-term toxicity, many
\nare expensive, and a proportion of patients has treatmentresistant
\ndisease.6 Biological therapies or ‘biologics’ describe
\nagents designed to block specific molecular steps important
\nin the pathogenesis of psoriasis and have emerged over the
\nlast 3–5 years as potentially valuable alternative therapeutic
\noptions.
\nCurrently, biological therapies for psoriasis comprise two
\nmain groups: (i) agents targeting the cytokine tumour
\nnecrosis factor (TNF)-a (e.g. etanercept, infliximab, adalimumab)
\nand (ii) agents targeting T cells or antigen-presenting
\ncells (e.g. efalizumab, alefacept). Two of these,
\netanercept (Enbrel) and efalizumab (Raptiva) were
\nlicensed in 2004 in the U.K. for patients with moderate to
\nsevere psoriasis.