That’s the question Dr. Kenneth Gordon of the Pritzker School at the University of Chicago posed to colleagues at the American Academy of Dermatology’s annual meeting in New Orleans. It was not meant to be rhetorical.
Given the huge pressure to use the new therapies – from patients, pharmaceutical manufacturers, and in some cases, the dermatologist’s own desire to use what appears to be the latest and greatest – there are a lot of potential costs.
The drugs, which include Amevive (alefacept), Enbrel (etanercept), Humira (adalimumab), Remicade (infliximab), and Stelara (ustekinumab), are hugely expensive (for a list of these drugs and their mechanisms, go here). Plus, there is a human cost – many of these biologics have the potential to cause infections, demyelinating disorders like multiple sclerosis, and cancer.
Psoriasis is a lifelong disease, and thus, therapies are taken more or less for life, noted Dr. Gordon, who also heads dermatology at the Northshore University Health System. But what is known about the long term safety of these biologics? There is little-to-no data beyond trial periods of 12-24 weeks in psoriasis patients. And although some of the drugs have been studied for longer in rheumatoid arthritis, Dr. Gordon said that it is not instructional to extrapolate the data to psoriasis.
When the first biologic came on the market in 2003, there was a great deal of excitement, he said. At that time, at least half of patients he treated were on methotrexate.
In his presentation, Dr. Gordon delved through the available data on efficacy and long term safety of older therapies like methotrexate, acitretin, and cyclosporine, and compared that to the biologics’ track record. So far, though there’s a big gap between knowledge and use for both the older and newer therapies.
What he concluded was that for moderate-to-severe patients, biologics probably pack a more powerful punch. Methotrexate is still a first-line choice for many psoriasis patients in his practice who are not as ill, but he says he still thinks of the drug as having had its heyday in the 1970s.
Where do biologics fit in your practice? Have your patients been better off since the advent of the therapies?
— Alicia Ault (on Twitter @aliciaault)