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The evidence implicating psoriasis as a T cell–mediated disorder has directed therapeutic efforts to immunoregulation. Cyclosporine and other immunosuppressive agents can be very effective in the treatment of psoriasis, and much attention is currently directed toward the development of biologic agents with more selective immunosuppressive properties and better safety profiles (Table 53-4). Experience with these agents is limited and information regarding combination therapy and adverse events continues to emerge. Use of TNF-α inhibitors may worsen congestive heart failure (CHF), and they should be used with caution in those at risk of or known to have CHF. . | Chapter 053. Eczema and Dermatitis Part 8 The evidence implicating psoriasis as a T cell-mediated disorder has directed therapeutic efforts to immunoregulation. Cyclosporine and other immunosuppressive agents can be very effective in the treatment of psoriasis and much attention is currently directed toward the development of biologic agents with more selective immunosuppressive properties and better safety profiles Table 53-4 . Experience with these agents is limited and information regarding combination therapy and adverse events continues to emerge. Use of TNF-a inhibitors may worsen congestive heart failure CHF and they should be used with caution in those at risk of or known to have CHF. Further none of the immunosuppressive agents used in the treatment of psoriasis should be initiated if the patient has a severe infection patients on such therapy should be routinely screened for tuberculosis. Malignancies including a risk or history of certain malignancies may limit the use of these systemic agents. Table 53-4 Biologics Approved for Psoriasis or Psoriatic Arthritis Mecha nism of Action Administration Agent Indic ation R oute Frequ ency Warnin gs Aleface Pt Anti- CD-2 Ps I M Once weekly x 12 weeks may repeat Lympho penia potential for increased malignancies serious infections Etanerc ept Anti TNF-a Ps PsA S C Once or twice weekly Serious infections neurologic events hematologic events potential for increased malignancies Efalizu mab Anti CD-11a Ps S C Once weekly Serious infections potential for increased malignancies thrombocytope nia hemolytic anemia psoriasis worsening Adalim umab Anti TNF-a PsA S C Every other week Serious infections neurologic events potential .
