9 Takeaways About Biologic Therapy for Pediatric Psoriasis

Laura E. Melnick, M.D., an assistant professor of clinical dermatology at Weill Cornell Medicine in New York, and her colleagues conducted a review of biological therapy for children with psoriasis that was published in the July issue of the journal Dermatologic Clinics.

Melnick, the corresponding author, and her colleagues note that the biological therapy has become “an appealing option for pediatric patient with moderate-to-severe psoriasis.” Patients report greater quality-of-life improvements with the biologics than with topical treatments, they said, and that rates of adherence are higher with biologic agents.

Here are nine takeaways from the review.

• Five biologic drugs have been approved as treatments for pediatric psoriasis by the FDA or the European Medicines Agency: Enbrel (etanercept), Humira (adalimumab), Stelara (ustekinumab), Cosentyx (secukinumab) and Taltz (ixekizumab).
• The European Medicines Agency has approved Humira as a treatment for pediatric plaque psoriasis in patients 4 years and older for whom topical agents and phototherapy have not worked, but it is not approved for pediatric psoriasis in the U.S. But the FDA has approved Humira for other conditions that affect children, juvenile idiopathic arthritis and Crohn’s disease in children.
• Six other biologics for the pediatric psoriasis are in various stages of development: guselkumab (approved for adults and sold as Tremfya), risankizumab (approved for adults and sold as Skyrizi), certolizumab pegol (approved for adults and sold as Cimzia), apremilast (approved for adults and sold as Otezla), tildrakizumab (approved for adults and sold as Ilumya) and deucravacitinib (approved for adults and sold as Sotyktu).
• The studies of guselkumab and risankizumab are supposed to wrap up next year so they may the first of those six biologics in development that the FDA will consider for approval for pediatric psoriasis.
• The studies of guselkumab, risankizumab, certolizumab pegol and deucravatinib are focused on adolescents (12 to 17 year olds). The apremilast and tildrakizumab trials are enrolling include children (6 to 11 year olds) as well as teens (12 to 17 year olds).
• No guidelines preference one of the biologics over another or one class of biologics over another, so the choice of which to use in children varies by “clinical context,”
   according to Melnick and her colleagues.
• Fear of needles is higher among children and infants so biologics with less frequent dosing might be preferred. Stelara, which is the only interleukin-12 and interleukin-23 inhibitor among the currently approved biologics for children, has less frequent dosing the than the interleukin-17 inhibitors, which include Cosentyx and Taltz.
• Pediatric psoriasis is associated with obesity and the tumor necrosis factor alpha inhibitors, which include Enbrel and Humira, have been shown to possibly have cardioprotective effects in adults. Whether they would afford the same protection in children has not been studied and is unknow,
• Many biologic agents should not be taken at the same time as livevaccines, a group that includes the vaccines against measles, mumps and rubella (given together), rotavirus and chickenpox.The review says that guidelines advise giving the vaccine two to four weeks before biologic therapy or three months after therapy biologic has ceased.