Rheumatology Drugs at a Glance, Part 2: Psoriasis

Guselkumab (Tremfya):²⁴ injection

Drug class: Monoclonal antibody, IL-23-RA

Warnings & Precautions

• Serious infections have occurred. Guselkumab may increase the risk of infection. Instruct patients to seek medical advice if signs or symptoms of clinically important chronic or acute infection occur. If a serious infection develops, discontinue the drug until the infection resolves.
• Prior to initiating treatment with secukinumab, evaluate for TB.

Dosage & Administration

Guselkumab is administered by subcutaneous injection. The recommended dose is 100 mg at Week 0, Week 4, and every eight weeks thereafter.

Commentary: Guselkumab was the first biologic approved that selectively blocks IL-23. It received FDA approval based on results from a clinical development program that included more than 2,000 patients. The most common adverse reactions (≥1%) are upper respiratory infections, headache, injection site reactions, arthralgias, diarrhea, gastroenteritis, tinea infections and herpes simplex infections.

Tildrakizumab-asmn (Ilumya):²⁵ injection

Drug class: Monoclonal antibody, IL-23-RA

Warnings & Precautions

• Hypersensitivity: If a serious allergic reaction occurs, discontinue tildrakizumab-asmn immediately and initiate appropriate therapy.
• Serious infections have occurred. Guselkumab may increase the risk of infection. Instruct patients to seek medical advice if signs or symptoms of clinically important chronic or acute infection occur. If a serious infection develops, discontinue the drug until the infection resolves.
• Prior to initiating treatment with tildrakizumab-asmn, evaluate for TB.

Dosage & Administration

Tildrakizumab-asmn is administered by subcutaneous injection. The recommended dose is 100 mg at Weeks 0 and 4, and every 12 weeks thereafter.

Commentary: The FDA approval was based on results from two clinical trials that enrolled 926 patients. There was significant improvement in patients who received tildrakizumab-asmn 100 mg compared with placebo. The most common adverse reactions (≥1%) are upper respiratory infections, injection site reactions, and diarrhea.

Mary Choy, PharmD, BCGP, FASHP, is a medical writer and editor living in New York City. She is the director of pharmacy practice for the New York State Council of Health-System Pharmacists.

References

1. Menter A, Strober BE, Kaplan DH, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019 Apr;80(4):1029–1072.
2. Mease PJ, Gladman DD, Papp KA, et al. Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics. J Am Acad Dermatol. 2013 Nov;69(5):729–735.
3. Patryk K, Marcinkiewicz K, Bergler-Czop B, et al. How does stigma affect people with psoriasis? Postepy Dermatol Alergol. 2017 Feb;34(1):36–41.
4. Zschocke I, Ortland C, Reich K. Evaluation of adherence predictors for the treatment of moderate to severe psoriasis with biologics: the importance of physician-patient interaction and communication. J Eur Acad Dermatol Venereol. 2017 Jun;31(6):1014:1020.
5. Poelman S, Keeling CP, Metelitsa AI, et al. Practical guidelines for managing patients with psoriasis on biologics: an update. J Cutan Med Surg. 2019 Jan/Feb;23(1_suppl):3S–12S.
6. The National Psoriasis Foundation. Financial assistance resource center.
7. Elmets CA, Leonardi CL, Davis DMR, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol. 2019 Apr;80(4):1073–1113.
8. Singh JA, Guyatt G, Ogdie A, et al. 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis. Arthritis Rheumatol. 2019 Jan;71(1):5–32.
9. FDA website. Otezla prescribing information. 2017 Jun.
10. FDA website. Humira prescribing information. 2018 Dec.
11. FDA website. Amjevita prescribing information. 2018 Mar.
12. FDA website. Cyltezo prescribing information. 2017 Aug.
13. FDA website. Hyrimoz prescribing information. 2018 Oct.
14. FDA website. Cimzia prescribing information. 2019 Feb.
15.  FDA website. Enbrel prescribing information. 2018 May.
16. FDA website. Remicade prescribing information. 2018 Jun.
17. FDA website. Inflectra prescribing information. 2018 Jul.
18. FDA website. Renflexis prescribing information. 2019 Mar.
19. FDA website. Ixifi prescribing information. 2017 Dec.
20. FDA website. Stelara prescribing information. 2018 Jun.
21. FDA website. Siliq prescribing information. 2017 Feb.
22. FDA website. Taltz prescribing information. 2018 May.
23. FDA website. Cosentyx prescribing information. 2018 Jan.
24. FDA website. Tremfya prescribing information. 2019 Jan.
25. FDA website. Ilumya prescribing information. 2018 Mar.