Current biologic therapies (including IL-17) and monitoring guidelines

This chapter reviews the efficacy and adverse effects of each drug and suggest pretreatment screening tests and ongoing monitoring that should be considered for each biologic therapy. Efficacy of treatments is described as the reduction of Psoriasis Area and Severity Index (PASI) score as reported in phase 3 clinical trials. The three TNF-a inhibitors approved for psoriasis are adalimumab, etanercept, and infliximab. Adalimumab is a fully human monoclonal antibody for both soluble and membrane-bound TNF-a. Inhibiting the host defenses leads to reactivation and atypical presentations of tuberculosis (TB) at a higher rate than in control populations. All patients starting a TNF-a inhibitor should be screened for latent tuberculosis (LTB) by obtaining a thorough history, examination, and testing prior to initiation of treatment. Traditionally, screening for LTB was performed via tuberculin skin test (TST); however, this is being replaced with the more sensitive and specific interferon gamma release assay (IGRA), also known as the QuantiFERON-TB Gold test.