Authors’ Personal Experience

Both of the authors of this review have found that the biologic agents have had a particularly important impact on those patients for whom other systemic therapies were inappropriate, contraindicated, or no longer tolerated. The availability of biologic agents, with their improved safety profiles, has allowed both authors to safely offer effective systemic therapy to more psoriasis patients. Both authors have fully integrated biologic agents into their dermatology practices and consider all systemic therapies (including biologic agents) equally for any psoriasis patient for whom topical or phototherapy is either ineffective or inappropriate. They both find that conventional therapies still play an important role in their approach to psoriasis treatment but that their use of certain therapies (particularly cyclosporine and PUVA) has declined. In Dr. Sobell's clinic, the goal is to achieve long-term control of psoriasis with monotherapy, and he has found that the biologic agents can provide this in most cases. In patients who are transitioning from methotrexate or cyclosporine to a biologic agent, however, he will continue the previous treatment for the initial 4 to 12 weeks of biologic therapy (4 weeks for efalizumab or etanercept; 12 weeks for alefacept) in order to avoid the disease worsening that can occur if methotrexate or cyclosporine is discontinued abruptly. Dr. Stone also tends to continue existing systemic or phototherapy during the first several weeks of biologic therapy. Both authors continue to investigate new ways to optimize treatment outcomes with biologic therapy for psoriasis and are actively involved in clinical studies of the currently approved and investigational biologic therapies.