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The off-label use of biologic therapies in dermatology

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Biological agents or simply 'biologics', refer to systemic immunotherapies that are protein-derived and cultured from living material (human, animal or micro-organisms) in a laboratory. Unlike conventional immunosuppressant therapies, which modulate the immune system in a broad and non-specific manner, biologics target specific mediators of inflammation, and therefore have superior efficacy and an enhanced safety profile when compared to drugs such as methotrexate, ciclosporin and mycophenolate mofetil. In recent years, a number of biologic agents have been developed to treat advanced malignant melanoma and chronic spontaneous urticaria; however, it is within the inflammatory dermatoses where the biologic agents first came to the fore in dermatology and continue to generate most interest in terms of off-label use. Moderate-to-severe psoriasis is the only inflammatory skin disorder for which biologic agents are currently licensed in the UK. Four biologic agents are recommended by the National Institute for Health and Care Excellence (NICE), namely adalimumab (Humira®), etanercept (Enbrel®), infliximab (Remicade®) and ustekinumab (Stelara®)(NICE, 2012), with many more in development. Biologics have revolutionised the treatment of severe psoriasis and have heralded a shift in thinking for the treatment of other difficult-to-treat inflammatory skin conditions. This article will briefly outline the mechanism of action of the most commonly used biologic agents and their 'off-label' use in various dermatological conditions.
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Document Type: Research Article

Publication date: March 1, 2015

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  • Dermatological Nursing is the quarterly, peer-reviewed journal of the British Dermatological Nursing Group (BDNG) and the UK's only quality dermatological nursing journal. It aims to provide cutting-edge articles on the treatment and management of dermatological conditions and the care of patients with skin problems. While the focus is on dermatological nursing, the information included is relevant to other healthcare professionals.
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