Biological therapy in dermatology

Rituximab 375mg/m2 weekly for 4weeks in pemphigus
Mechanism of action for Rituximab:
It is anti CD20 monoclonal antibody.

Biological agents in psoriasis:
1) Ustekinumab:
45 mg SC on week 0,4, then every 12 weeks

2) Secukinumab:Initial: 300 mg SC at weeks 0, 1, 2, 3, and 4
Monthly maintenance: Beginning at week 8, give 300 mg SC once monthly
For some patients, a dose of 150 mg may be acceptable

3) Adalimumab: 80mg SC on day 1
                        40mg on day 8
                        40 mg every 2 weeks

These agents can be combined with phototherapy or methotrexate.

 Ustekinumab has shown maximum disease free period after treatment.
Remember:
All biological agents are found to be less effective in obese patients when used as a monotherapy.

Adalimumab can be used in hidradenitis suppurativa cases.

First generation biological agents for psoriasis: etarncept, Adalimumab, inflixiamb
These agents target TNF -alpha.
Second generation: Ustekinumab acts against IL-12/23( pro- inflammatory cytokines)
Third generation: targets IL-17.