Inflixiamab (Remicade)

This is a monoclonal antibody targeted against human tumor necrosis factor-alpha. It is bound to newly bound surface and soluble circulating TNF. It is a chimeric molecule - meaning a human-mouse combination.

Dosage

Indications

This drug is currently used for Crohn’s disease and rheumatoid arthritis. In a small study this drug was shown to produce improvement in ninety percent of patients when given the drug at a dose of 10 mg/kg and eighty-two percent of those given 5 mg/kg both administered intravenously. The drug was given at baseline, two weeks and six weeks.

At 10 weeks 82% of patients achieved a PASI 75 response.

The response to treatment is rapid.

Side Effects

Local reactions at the site of infusion are quite common occurring in about sixteen percent of patients. This consists of fever, chills, itching, hives as well as chest pain and changes in blood pressure. Shortness of breath was also reported. Serious side effects of infection producing pneumonia, cellulitis was described in three percent of the drug treated patients as opposed to two percent in the placebo group.

Immunosuppressants concerned about reactivation of tuberculosis is a potential problem as is the development of systemic lupus erythematosus.

Since this is a mouse-human molecule antibodies to the mouse component develop.This means that often the dose has to be increased with time because of the development of antibodies to the drug . Methotrexate is used to suppress this reaction.This drug has been used in combination with methotrexate and systemic corticosteroids.

Dovobet®

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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.