ABSTRACT
This chapter reviews the available data on biologic fatigue for the medications approved to treat moderate to severe psoriasis. It provides practical recommendations to clinicians for optimally managing patients on biologic medications in order to minimize biologic fatigue. Thus, the development of antidrug antibodies is thought to be the key driver of biologic fatigue. In addition, patients with the most severe, recalcitrant disease or those who have a history of developing antibodies to a previous agent may be at increased risk of biologic fatigue. The long-term efficacy of etanercept for the treatment of psoriasis was analyzed in a 96-week study of more than 600 patients. Etanercept is a dimeric fusion protein consisting of two tumor necrosis factor-receptors linked to the fragment crystallisable portion of immunoglobulin G1. Likewise, constant dosing of ustekinumab, etanercept, and adalimumab is recommended for all patients.
