Biologic use beyond psoriasis
Biologic medications are being approved for and showing promise in the treatment of skin diseases other than psoriasis. Last year, the FDA approved the anti-IgE antibody omalizumab (Xolair, Roche/Genentech and Novartis) for the treatment of chronic idiopathic urticaria.
“Probably one of the biggest recent steps forward in dermatology was to have an approved biologic treatment for chronic idiopathic urticaria,” said Michael P. Heffernan, M.D., who is a clinical assistant professor of dermatology at Indiana University School of Medicine, Indianapolis, Ind., in private practice at the San Luis Dermatology and Laser Clinic and San Luis Obispo, Calif., and who led the Biologic Therapy in Dermatology beyond Psoriasis forum in March 2015, at the American Academy of Dermatology’s annual meeting in San Francisco.
Dermatologists are increasingly using the medications off-label for a range of skin conditions, including blistering and granulomatous diseases, according to Dr. Heffernan. In the vast majority of these diseases, the dosing regimen is the same as that used for psoriasis, he said.
Rituximab for blistering diseases
In diseases such as pemphigus vulgaris, the off-label use of anti-B-cell therapies is gaining ground as an alternative or adjuvant therapy to systemic treatments.1
“There’s a great deal of data [looking at] the CD20 antibody rituximab for the treatment of autoimmune blistering diseases, such as pemphigus, but also pemphigoid, epidermolysis bullosa acquisita and mucous membrane pemphigoid 2,” Dr. Heffernan said.
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The medications have moved into clinical practice--in many cases, up towards the first line of treatment for these significant life-altering blistering diseases, he said. The biggest side effect is the cost and concerns about certain infections, including progressive multifocal leukoencephalopathy, which haven’t been seen in autoimmune blistering disease patients to date, according to Dr. Heffernan.
In a meta-analysis published earlier this year, researchers analyzed 30 studies with 578 patients, looking at the efficacy of different rituximab dosing regimens for treating pemphigus. More than three-quarters of the patients achieved complete remission after one cycle of the drug. Eighteen patients (3.3 percent of the total) developed serious adverse effects. While the researchers did not find significant differences in complete remission and relapse rates between patients treated with high-dose (near or≥ 2,000 mg/cycle) versus low-dose (< 1,500 mg/cycle) rituximab, they found the higher dosing was associated with a longer complete remission duration. Overall, the study’s authors said rituximab is efficacious and well-tolerated for treating pemphigus.3