Long-term
therapy is often required for
psoriasis. This article reviews the most recent long-term clinical data for
biological agents that have been approved or for which late-stage development data have been released for the treatment of patients with moderate to severe plaque
psoriasis. Efficacy data are available for up to five 12-week courses of
alefacept (approximately 60 weeks of
therapy), 36 months (144 weeks) of continuous
efalizumab, 48 weeks of continuous
etanercept, and 50 weeks of bimonthly
infliximab. Data sources include publications, product labeling, and posters presented at recent international scientific meetings.
Alefacept appears to continue to be efficacious over multiple treatment courses for some responsive patients. The efficacy of
efalizumab achieved during the first 12-24 weeks of
therapy appears to be maintained or improved through at least 60 weeks of continuous treatment. The efficacy of
etanercept appears to be maintained through at least 48 weeks of continuous treatment.
Infliximab demonstrates a high response rate soon after initiation, which appears to be maintained through 24 weeks but declines modestly with
therapy out to 50 weeks. After 48 weeks, approximately 60% of
efalizumab-treated and 45% of
etanercept-treated patients remaining on
therapy achieved > or =75% improvement from baseline in
Psoriasis Area and Severity Index, as did 70.5% of
infliximab patients who did not miss more than two infusions. Safety data suggest that these agents may be used for long-term administration. Long-term data from
psoriasis trials continue to accumulate. Recent data suggest that
biological therapies have efficacy and safety profiles suitable for the long-term treatment of patients with moderate to severe
psoriasis.