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Chapter 053. Eczema and Dermatitis (Part 8)

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The evidence implicating psoriasis as a T cell–mediated disorder has directed therapeutic efforts to immunoregulation. Cyclosporine and other immunosuppressive agents can be very effective in the treatment of psoriasis, and much attention is currently directed toward the development of biologic agents with more selective immunosuppressive properties and better safety profiles (Table 53-4). Experience with these agents is limited and information regarding combination therapy and adverse events continues to emerge. Use of TNF-α inhibitors may worsen congestive heart failure (CHF), and they should be used with caution in those at risk of or known to have CHF. ...

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  1. Chapter 053. Eczema and Dermatitis (Part 8) The evidence implicating psoriasis as a T cell–mediated disorder has directed therapeutic efforts to immunoregulation. Cyclosporine and other immunosuppressive agents can be very effective in the treatment of psoriasis, and much attention is currently directed toward the development of biologic agents with more selective immunosuppressive properties and better safety profiles (Table 53-4). Experience with these agents is limited and information regarding combination therapy and adverse events continues to emerge. Use of TNF-α inhibitors may worsen congestive heart failure (CHF), and they should be used with caution in those at risk of or known to have CHF. Further, none of the immunosuppressive agents used in the treatment of psoriasis should be initiated if the patient has a severe infection; patients on such therapy should be routinely
  2. screened for tuberculosis. Malignancies, including a risk or history of certain malignancies, may limit the use of these systemic agents. Table 53-4 Biologics Approved for Psoriasis or Psoriatic Arthritis Mecha Administration nism of Agent Action Indic R Frequ Warnin ation oute ency gs Aleface Anti- Ps I Once Lympho pt CD-2 M weekly x 12 penia, potential weeks; may for increased repeat malignancies, serious infections Etanerc Anti Ps, S Once Serious ept TNF-α PsA C or twice infections, weekly neurologic events, hematologic
  3. events, potential for increased malignancies Efalizu Anti Ps S Once Serious mab CD-11a C weekly infections, potential for increased malignancies, thrombocytope nia, hemolytic anemia, psoriasis worsening Adalim Anti PsA S Every Serious umab TNF-α C other week infections, neurologic events, potential for
  4. increased malignancies, hypersensitivit y reactions, hematologic events Inflixi Anti PsA IV Initial Serious mab TNF-α infusion infections, followed by hepatotoxicity, infusions at hematologic week 2, 6, events, then every 8 hypersensitivit weeks y reactions, neurologic events, potential for increased malignancies Ps, psoriasis; PsA, psoriatic arthritis; IM, intramuscular; SC, subcutaneous; TNF, tumor necrosis factor.
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