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Comprehensive Treatment Information for Canadian Dermatologists
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Psoriasis - Patient's guide
Biologic Drugs and How They Work
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We are entering a very exciting stage in medical treatment in that drugs have been designed to specifically hit immunological targets that are involved in specific conditions. Previous immune therapy has involved drugs that have a general suppressing effect on the immune system which consequently prevents high doses being used because of the fear of side effects. Theoretically the more specific the target to be blocked, the less interference with other biological functions - making the drug safer.
These new drugs are known as biological drugs. They are created in living cells. The technique has been used for a long time for drugs such as insulin or interferon.
There are a number of new biologic drugs that are currently used in psoriasis.
- Alefacept (Amevive) (Click here to view the A-Detail™ on Alefacept (Amevive®))
- Efalizumab (Raptiva)
- Inflixiamab (Remicade)
- Etanercept (Enbrel)
Explanation of the difficult drug names:
The suffix denotes the drug class.Mab = monoclonal antibody
Ximab = chimeric(mouse-human) monoclonal antibody
Zumab = Humanized monoclonal antibody-ie. Reducing the amount of mouse to under10%
Umab = Human monoclonal antibody
Cept = receptof –antibody fusion protein that mimics an immunoglobulin
These drugs can target different steps in the pathway of producing psoriasis. The following general targets have been identified and can be blocked.
- T-cell activation
- Inhibiting memory or activated T-cells
- Blocking the migration of T-cells into the skin
- Inhibiting the chemicals or cytokines produced eg. tumor necrosis factor
- Blocking conversion of one cytokine into another
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INTRODUCTION
Dovobet (50 micrograms/gram calcipotriol and 0.5 milligrams/gram betamethasone dipropionate) is a topical ointment approved for use in Canada to treat plaque psoriasis. Dovobet has become the topical therapy of choice for many patients with plaque type psoriasis not involving the face or skin folds... | Read more ... -
CLININCAL EXPERIENCE
More than six international studies involving over 6,000 patients have shown reductions in the PASI (Psoriasis Area and Severity Index) of approximately 40% after one week of treatment and 70% after four weeks... | Read more ... -
INDICATIONS
Used to treat chronic plaque psoriasis that covers less than 30% of the body surface (see following slides for clarification). Dovobet is not often used to treat the scalp because the sticky base does not allow for easy application or removal... | Read more ... -
PATIENT PROFILE
Patients with chronic plaque psoriasis that covers less than 30% of the body surface. In some cases, a patient could use it on a greater BSA if he/she wanted to as long as the use/week is 100 g per week or less... | Read more ... -
DOSING
Dovobet should be applied to the affected area once daily for four weeks. Several studies have shown that there are no statistically significant differences between applying the ointment once daily or twice daily... | Read more ... -
EFFICACY
Six international studies involving more than 6,000 patients using Dovobet to treat psoriasis have shown PASI reductions of approximately 40% after one week of treatment and 70% after four weeks. Additional studies have shown that Dovobet has superior... | Read more ... -
COMPLIANCE
Compliance is aided by the convenience of the once daily dosing of Dovobet. Compliance is also less of a problem than with most products due to the rapid onset of action. Significant improvement is usually seen within the first week... | Read more ... -
SIDE EFFECTS, SAFETY AND RISKS
Because Dovobet is a combination drug, the frequency of side effects reported is less than would be expected if using each compound on its own: for example, the anti-inflammatory action of the corticosteroid (betamethasone dipropionate) minimizes the irritation often reported when using calcipotriol alone... | Read more ... -
COST OF TREATMENT
It is probably the single most effective topical therapy available for psoriasis, so patients are generally prepared to pay for this. It is somewhat more expensive than the equivalent potent topical steroid, but the rapid and significant improvement in quality of life... | Read more ...
View the entire Dovobet® presentation.
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Last modified: Tuesday, 17-Aug-2010 12:02:45 MDT