Biologic Response Modifiers and Pediatric Psoriasis

Abstract

The efficacy and safety of biologic response modifiers such as etanercept, adalimumab, infliximab, and ustekinumab have been demonstrated in the treatment of psoriasis in adults, but none are currently approved for the treatment of psoriasis in children in the United States, and only etanercept is approved for the treatment of psoriasis in children in the European Union. Through case reports, case series, and a large clinical trial of the use of etanercept, the literature supports the use of these agents to treat psoriasis in children. Data on the use of the tumor necrosis factor-α antagonists etanercept, adalimumab, and infliximab in the treatment of other inflammatory diseases in children-namely Crohn's disease, juvenile arthritis, and uveitis--support their safety profile in children.

Challenges in the treatment of psoriasis with biologics: vaccination, history of malignancy, human immunodeficiency virus (HIV) infection, and pediatric psoriasis

“…Adalimumab has received approval in Europe for the treatment of psoriasis in children ≥4 years of age, with good therapeutic outcome and without serious concerns for its safety profile . As far as infliximab is concerned, so far no large scale studies in the pediatric population have been conducted; there are, however, isolated case reports that seem to show a significant efficacy in children . In most of these cases, however, the dosage is not standardized like in adults but is rather individualized according to the patients’ characteristics and comedication .…”

“…As far as infliximab is concerned, so far no large scale studies in the pediatric population have been conducted; there are, however, isolated case reports that seem to show a significant efficacy in children . In most of these cases, however, the dosage is not standardized like in adults but is rather individualized according to the patients’ characteristics and comedication . Although infliximab has not yet received approval for the indication of psoriasis in children, neither in the US nor in Europe, it has received approval for the treatment of pediatric Crohn's disease and ulcerative colitis in children ≥6 years of age .…”

“…In most of these cases, however, the dosage is not standardized like in adults but is rather individualized according to the patients’ characteristics and comedication . Although infliximab has not yet received approval for the indication of psoriasis in children, neither in the US nor in Europe, it has received approval for the treatment of pediatric Crohn's disease and ulcerative colitis in children ≥6 years of age . The paradoxical phenomenon of infliximab‐induced psoriasiform lesions among those patients is not rare .…”

“…Although infliximab has not yet received approval for the indication of psoriasis in children, neither in the US nor in Europe, it has received approval for the treatment of pediatric Crohn's disease and ulcerative colitis in children ≥6 years of age . The paradoxical phenomenon of infliximab‐induced psoriasiform lesions among those patients is not rare . Data on certolizumab pegol and pediatric psoriasis are extremely limited, however, there are reports on its successful off‐label use in other conditions, such as JIA (juvenile idiopathic arthritis) .…”

“…The introduction of biologics has been accompanied with excellent therapeutic outcomes for the psoriatic patients and has even brought hope for a long‐term complete remission of psoriasis in these patients . While their administration in otherwise healthy adults does not seem to constitute a problem for most physicians, the confrontation with special cases such as pediatric patients, patients with an HIV history as well as patients with previous malignancies or with unclear vaccination status, can be challenging.…”