Registration benefits include: Access to CME/CE programs and certification Free subscription to Biologic Bulletin newsletter Reminders of new CME/CE activities REGISTER NOW This Web site is supported by an unrestricted educational grant from Genentech, Inc. Ask the Expert : Search Results Search Results 40 question(s) listed Efficacy Transitioning between biologic therapies How do you transition between biologic therapies if a patient is not doing well on one and you want to switch them to another? (from Alabama)   Click Here To Read Answer Worsening of disease while on efalizumab If a patient on efalizumab is experiencing a worsening of their disease on therapy, what should I do? (from Mississippi)   Click Here To Read Answer Unsustained response after second course of alefacept I have a patient who achieved about 30% improvement with alefacept. I gave him a second course, and he cleared about 80% to 90%, but he is not having a sustained remission. It’s been only a few weeks,...   Click Here To Read Answer Hand and Foot Plaque Psoriasis (with or without pustules) Hand and foot psoriasis has been notoriously hard to treat. I have recently had good experience using RAPTIVA® (efalizumab) in hand and foot psoriasis and wondered if others have had experience with t...   Click Here To Read Answer Loss of Efficacy With Etanercept After trying multiple treatment modalities, including UVA and UVB, combination therapy, MTX, etc, I started treatment with Enbrel® (etanercept) for my psoriasis approximately 2 years ago, with excelle...   Click Here To Read Answer Biologic agents in a patient with lymphoma Are there any biologics for psoriasis that may be used if a patient has a history of lymphoma? Which biologics would be preferred?   Click Here To Read Answer When to switch to another therapy I have a 43-year-old female patient with psoriasis on the palms, elbows, and knees who has been receiving etanercept for 12 months now at the package-indicated dose (including step down after 3 months...   Click Here To Read Answer Side Effects/Safety Signs of a demyelinating disorder If I have a patient on an anti-TNF agent and I think there may be signs of a demyelinating disorder, such as paresthesia, balance issues, confusion, vision impairment, etc, what should I do? (from Cal...   Click Here To Read Answer Generalized pruritus with Enbrel Have you ever seen generalized pruritus with Enbrel (etanercept)?   Click Here To Read Answer Use of biologic agents with Mucha-Habermann disease. Would you have any reservations or concerns about using Enbrel (etanercept) or any other biologics in a patient with an undocumented (but probably accurate) diagnosis of Mucha-Habermann disease approx...   Click Here To Read Answer Papular eruption and arthropathies with therapy I have a 50-year-old female patient who did not respond to Enbrel (etanercept). It was stopped in April and in mid-May she was started on Raptiva (efalizumab). Ten days ago she developed a widespread ...   Click Here To Read Answer Edema after efalizumab injection I have a patient on RAPTIVA (efalizumab) who developed a side effect after injecting himself in the same anterior thigh for 6 weeks before realizing he should rotate the sites. His psoriasis has done ...   Click Here To Read Answer ANA Screening I have dozens of patients on biologic therapy for psoriasis. Do you think it's good medicine to obtain an ANA screening on all potential biologic therapy patients?   Click Here To Read Answer What antimalarial would you recommend for a patient on biologics? I have recently read that chloroquine exacerbates psoriasis. How often does this occur? What antimalarial would you recommend for a patient on biologics with mild to moderate psoriasis?   Click Here To Read Answer Using etanercept to treat patients with history of hepatitis B How do you feel about using etanercept to treat patients who have a history of hepatitis B but are in remission? Do you feel it is absolutely contraindicated, or do you believe that patients may recei...   Click Here To Read Answer Use of biologics in a patient that had breast cancer 10 years ago I have a patient with severe psoriasis (>70% BSA) who is >10 years out from breast cancer. She has also had hepatitis C. She says her oncologist has advised her not to use any biologics or ultraviolet...   Click Here To Read Answer Severe pruritic psoriasis My patient is a 53-year-old male with severe pruritic psoriasis. He did reasonably well with alefacept at one point, but his psoriasis began to flare badly and I placed him on efalizumab. He recently ...   Click Here To Read Answer Side effect in biologic therapies My 23-year-old daughter has been on efalizumab for almost 3 years. After always having normal pap smears, she suddenly started receiving reports of low-grade squamous cells. In addition, she has recen...   Click Here To Read Answer Association between efalizumab and Guillain-Barré syndrome Is there an association between treatment with efalizumab and Guillain-Barré syndrome?   Click Here To Read Answer Etanercept use in a male patient trying to start a family What is the advice to give a male patient regarding contraception if he is due to start etanercept as he and his wife are trying to have a baby?   Click Here To Read Answer Transitioning from alefacept in a patient who developed lymphopenia I have patient who had been treated successfully with 2 courses of alefacept in the past 12 months. While on his third course he developed lymphopenia, and his CD4+ counts have remained below 250 cell...   Click Here To Read Answer Dosing & Administration Transitioning off a biologic agent How long should I overlap agents if I am transitioning off a biologic agent—especially efalizumab? (from New York)   Click Here To Read Answer Prohibitive costs of stepping up dose of etanercept I have a patient on etanercept who I had to step down from double-dose, and they subsequently flared. I can’t get insurance to agree to stepping the dose back up. What should I do?   Click Here To Read Answer Controlled diabetic patient undergoing renal dialysis I have a controlled diabetic patient with extensive plaque psoriasis who is undergoing renal dialysis for end-stage renal disease. Have you tried Raptiva (efalizumab) on this type of patient?   Click Here To Read Answer Incomplete response with etanercept. I have a patient with severe psoriasis who has been on Enbrel (etanercept) 50 mg twice a week for the past 4 months. Her erythema has improved considerably, but she still has thick hypertrophic plaque...   Click Here To Read Answer Congenital Psoriasis What is the latest treatment for congenital psoriasis? (From New York)   Click Here To Read Answer Etanercept and Patient’s Weight In stepping down the dose of etanercept, it seems to me that the heavier-weight patients are the ones I am having trouble dose-reducing and maintaining a response. Do you think this is related to the ...   Click Here To Read Answer Weight-Based Dosing Does it seem to anyone besides me that patients do better with the biologic agents that are given by weight-based dosing than by fixed-weight dosing? Is there any effort to change the dosing from fixe...   Click Here To Read Answer Hepatitis and Biologic Agents What, if any, biologic agents may be considered for use in a psoriasis patient with chronic hepatitis C infection? Should all patients be screened for hepatitis C before we start treating them with bi...   Click Here To Read Answer Avoiding psoriasis flare When coming off of raptiva, how do you recommend weaning off to avoid a psoriasis flare?   Click Here To Read Answer Frequency of follow-up visits For a patient who has been on etanercept for a year, has reached good stable control and good tolerance, how frequently should follow-up visits be scheduled? Every 3 months, or would every 4—6 ...   Click Here To Read Answer Increased dosing frequency with infliximab I have a patient with recalcitrant psoriasis who has tried all the available biologics. He is currently on infliximab and has been for 3–4 months. Because of flaring, he is also on 2 mg/kg/day of cycl...   Click Here To Read Answer Treatment options after unsatisfactory results with efalizumab and etanercept A patient who has had minimal responses to efalizumab and etanercept now notes a good response to infliximab, but only if he receives the 5 mg/kg dose every 4 weeks. Is this OK? Are there any other op...   Click Here To Read Answer Treatment Considerations Patient with psoriasis and psoriatic arthritis and family history of multiple sclerosis I have a 40-year-old patient with moderate (40% body surface area) psoriasis and psoriatic arthritis who is a Fitzpatrick type I skin type. He has been on methotrexate for over a year. The patient rep...   Click Here To Read Answer Biologics in patient with lung carcinoma A 60 year-old woman recently had bronchoalveolar lung carcinoma removed with good prognosis. She cannot tolerate acitretin or ultraviolet B (UVB) therapy. She had previously been on methotrexate. Coul...   Click Here To Read Answer Etanercept in a patient with melanoma I have a psoriasis patient who was recently diagnosed with (and treated for) melanoma: 0.68 mm, Clark level III. Is etanercept contraindicated in this situation?   Click Here To Read Answer Treatment options for severe nail psoriasis I have psoriatic arthritis and mild psoriasis that has affected my toenails and fingernails quite severely. My dermatologist has recommended etanercept. Do you have any other treatment suggestions tha...   Click Here To Read Answer Pregnancy and the use of biologics A 32-year-old female patient who has had chronic moderate psoriasis since age 22 had success with etanercept for the past 18 months. She is now trying to get pregnant, but she is concerned about remai...   Click Here To Read Answer Treatment options for a patient with plaque psoriasis and a history of hepatitis C and throat cancer Do you have any treatment suggestions for a 67-year-old male who has severe plaque psoriasis, a history of hepatitis C, and laryngectomy for throat cancer 5 years ago, and who previously did not respo...   Click Here To Read Answer Biologic treatment in patients with successfully treated skin cancer I recently had a squamous cell carcinoma that was caused by too many PUVA treatments removed. Is there a biologic that would be safe for my very severe psoriasis, even though I have had skin cancer? I...   Click Here To Read Answer   Ask the Expert Home