Biologics in dermatology: adverse effects

Abstract

Biologics are a group of drugs that precisely affect certain specific steps in the immune response and are an extremely useful group when used in an appropriate setting. However, their use can often be a double-edged sword. Careful patient selection and thorough knowledge of adverse effects is a key to their successful use in various disorders. The initial enthusiasm has gradually given way to a more cautious approach wherein a balance is sought between clinical usefulness and expected side effects. The adverse effects of the biologics most commonly used in dermatology have been carefully listed for ready reference. The plausible causes of the adverse reactions are succinctly outlined along with their incriminating factor(s). Besides, in brief, the attention has been focused on their management. The content should provide an essential didactic content for educating the practitioner.

Ustekinumab for skin reactions associated with anti‐tumor necrosis factor‐α agents in patients with inflammatory bowel diseases: A single‐center retrospective study

“…Our patients had predominantly inverse and pustular psoriatic lesions. It seems that aseptic palm and sole pustular lesions are the most common psoriatic pattern described in paradoxical psoriasis induced by anti‐TNF‐α treatments . Injection‐site reactions have also been frequently reported, as well as anaphylactoid reactions .…”

Varicella zoster virus meningitis under ustekinumab because of plaque psoriasis

“…2 Data from the Psoriasis Longitudinal Assessment and Registry (PSOLAR) suggest a higher risk of serious infections with adalimumab and infliximab compared with non-methotrexate and non-biologic therapies, but no increased risk with ustekinumab or etanercept. 2 Data from the Psoriasis Longitudinal Assessment and Registry (PSOLAR) suggest a higher risk of serious infections with adalimumab and infliximab compared with non-methotrexate and non-biologic therapies, but no increased risk with ustekinumab or etanercept.…”

Mechanism of action of the biologics used in the treatment of plaque psoriasis

“…The most common adverse effects of ADA and ETN (subcutaneous use) are reactions in application sites while the most common adverse effects related to INF (intravenous use) are infusion reactions [5]. Another common side effect of anti-TNF agents are common infections (especially of the upper respiratory tract) [5].…”

“…The most common adverse effects of ADA and ETN (subcutaneous use) are reactions in application sites while the most common adverse effects related to INF (intravenous use) are infusion reactions [5]. Another common side effect of anti-TNF agents are common infections (especially of the upper respiratory tract) [5]. As a result of the immunological alterations provoked by TNF-α inhibitors, the use of these drugs has been associated with severe infections of viral, bacterial and fungal etiology so it is essential to properly monitor the patients using these drugs and to know all their common and rare possible adverse effects [1-3, 5].…”

“…Finally, it is a very effective drug [4] and has an excellent safety profile for the treatment of plaque psoriasis. Nasopharyngitis, upper respiratory tract infection and headache are reported as the most common adverse effect of UST [5,9,11]. IL-17 (or IL-17A) is a key cytokine in the immunopathogenesis of psoriasis [7].…”