Psoriasis Guideline: Anti-TNF Biosimilars Can Be Considered Therapeutically Interchangeable With References

New psoriasis treatment guidelines released this month by the American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF) outline the use of biologics in treating and managing psoriasis.

The guideline was developed by a multidisciplinary work group of dermatologists, a rheumatologist, a cardiologist, and patient advocacy group representatives, and expands upon a 2008 guideline that was released prior to the advent of biosimilars in the United States.

In the newly published document, AAD and NPF describe the biologics currently used in treating psoriasis, including the anti—tumor necrosis factor (anti-TNF) agents etanercept, infliximab, adalimumab, and certolizumab. Notably, the guideline states that “[anti-TNF] biosimilars approved by the FDA should be considered similar to the reference branded version of the drug and therefore interchangeable.” It also highlights the fact that all recommendations made for treatment with reference anti-TNF agents “apply similarly to biosimilar versions” of these products.

The guideline also discusses interleukin (IL) inhibitors, including the IL-12/23 inhibitor ustekinumab; the IL-17 inhibitors secukinumab, ixekizumab, and brodalumab; and the IL-23 inhibitors guselkumab, tildrakizumab, and risankizumab.

The guideline notes that all of the approved biologics may lose efficacy in a patient who initially responds well to treatment, and while the use of concomitant methotrexate has been linked with increased biologic drug survival in other inflammatory diseases, there is limited reported use of methotrexate with biologics for the treatment of psoriasis, and there are no randomized controlled trials on which to base a recommendation for combined therapy at this time.

“Before starting any psoriasis treatment, it’s important for patients to understand its potential effects, both positive and negative,” said Alan Menter, MD, FAAD, cochair of the guidelines work group, in a statement. “This guideline provides physicians with the information they need to discuss biologic medications with their patients and help them choose the treatment plan that’s best for them.”

Also published by the AAD and NPF this month was a guideline on treating psoriasis with awareness and attention to comorbidities, which includes recommendations on managing psoriasis in the context of common comorbidities including psoriatic arthritis, cardiovascular disease, metabolic syndrome, and inflammatory bowel disease.

The AAD and NPF report that they will publish another 4 guidelines, addressing phototherapy, the treatment of pediatric patients, non-biologic systemic therapies, and topical therapy.

Reference

Menter A, Strober BE, Kaplan DH, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics [published online February 13, 2019]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.11.057.