Dermatologic inflammatory conditions require high loading and maintenance doses of biologic therapy

Abstract

Biologic therapies are used to treat multiple inflammatory diseases, including psoriasis. In most regimens, loading doses are used to reduce the time to therapeutic drug levels and, ideally, shorten the time to clinical response. 1 Despite widespread use, there is limited evaluation of whether drug regimens with loading doses yield better clinical outcomes compared with nonloading dose regimens, especially given their increased cost and resulting pressure on physicians from payors to forego them. [2][3][4] Published reasons for loading dose use include the need for more drug to achieve than maintain disease control, to neutralize or prevent the formation of anti-drug antibodies and to achieve therapeutic drug levels in protein-losing enteropathies, like Crohn's disease and ulcerative colitis. 1,5,6 However, there is no clear pattern of biologic therapy use, as regimens with loading doses are recommended for some biologics but not others, sometimes independent of half-life and drug. 1 This study seeks Table 1 FDA-approved biologic therapy regimens by therapy and indication 5,7 Adalimumab PsO/Uveitis: 80 mg initial dose, followed by 40 mg every other wk starting one wk after initial dose PsA/RA/AS: 40 mg every other wk CD/UC/HS: Day 1: 160 mg, day 15: 80 mg, day 29: maintenance 40 mg every other wk Adalimumab-adbm PsO: 80 mg initial dose, followed by 40 mg every other wk starting one wk after initial dose PsA/RA/AS: 40 mg every other wk CD/UC: Day 1: 160 mg, day 15: 80 mg, day 29: maintenance 40 mg every other wk BrodalumabPsO: 210 mg at wks 0, 1 and 2, followed by 210 mg every 2 wks Certolizumab pegolPsO: 400 mg every other wk PsA/RA: 400 mg initially and at wks 2 and 4, followed by 200 mg every other wk AS/nr-axSpA: 400 mg initially at wks 2 and 4, followed by 200 mg every other wk or 400 mg every 4 wks CD: 400 mg initially and at wks 2 and 4, followed by 400 mg every 4 wks Etanercept PsO: 50 mg twice wkly for 3 months, followed by 50 mg once wkly PsA/RA: 50 mg once wkly with or without methotrexate AS: 50 mg once wkly Etanercept-szzs PsO: 50 mg twice wkly for 3 months, followed by 50 mg once wkly