boards fodder

Dermatology Biologics Chart

By Emily C. Milam, MD

DRUG CLASS & FDA OFF-LABEL USES DOSING ROUTE MONITORING PREG. SIDE EFFECTS/ NOTES
MECHANISM APPROVED IN DERMATOLOGY CATEGORY ADVERSE EVENTS
INDICATIONS

Adalimumab TNF-α Inhibitor Dermatologic:  PG Plaque psoriasis SubQ Before starting: B Common: Injection Syringe contains
(Humira)  Psoriasis  Behcet’s  Initial dose of Test for TB site reaction, URI, UTI, latex.
Fully human  HS disease 80mg, followed by and hepatitis headache, nausea,
recombinant  Aphtous sto- 40mg every other B. Consider rash, HLD, abdominal Avoid live vac-
antibody; binds matitis week (starting 1 testing for or back pain, flu-like cines.
specifically to  Other neu- week after initial hepatitis C symptoms, HTN, hyper-
TNF-α, block- Other: trophilic derma- dose) and HIV. sensitivity reactions. Lupus-like
ing interaction  PsA toses syndromes and
with p55 and  RA  Vasculitis HS  160 mg Interval Rare But Serious: CHF; autoimmune
p75 cell sur-  JIA  Pustular der- (given in 1 day Monitoring: melanoma & NMSC; hepatitis can
faces.  Crohn’s matosis or split over 2 Annual TB uveitis; central demy- arise in patients
disease  PRP consecutive days), Test. elinating disorders; on TNF-α inhibi-
 UC  IgA pem- followed by 80 mg Routine cytopenias; new-onset tors
 AS phigus on day 15, and TBSE. psoriasis (especially
 Uveitis  Sarcoidosis then 40 mg every palmoplantar pus- Efficacy may
 Disseminated week starting on tulosis); cutaneous wane over time
GA day 29 small vessel vasculitis; due to develop-
 SAPHO syn- eczematous eruptions; ment of neutral-
drome lichenoid dermatitis. izing anti-chime-
 Relapsing ric antibodies.
polychondritis Black Box Warnings:
1. Serious and fatal Avoid concurrent
infections administration
2. Lymphoma and other with IL-1 recep-
malignancies tor antagonists
(ie Anakinra).
Screen for: CHF, IBD,
demyelinating diseases

Alefacept Anti-T-cell Dermatologic:  Lichen planus Psoriasis  IM, IV Before starting: B Common: Injection No longer avail-
(Amevive) agent.  Psoriasis  SCLE IV: 7.5mg once Test CD4+ site reaction, infec- able in the US;
 Chronic GVHD weekly x 12 weeks T-cell count tions, hypersensitivity discontinued by
Recombinant  ?Alopecia (should be reactions (urticarial, pharmaceutical
humanized Other: None areata IM: 15mg once >500 cells/ angioedema). Causes company.
fusion protein  ?PG weekly x 12 weeks mcl). lymphopenia and
that binds  ?Cutaneous T a dose-dependent
to CD2 and cell lymphoma Interval decrease in CD4+ and
inhibits T-cell Monitoring: CD8+ T-cell counts.
activation, and CD4+ T-cell
selectively count every Rare But Serious:
reduces mem- other week. Hepatotoxicity;
ory T cells. Potentially increased
risk of malignancy.

Contraindications:
1. CD4 count < 250
cells/mcl
2. HIV infection
3. Active infection or
malignancy

Apremilast PDE-4 Inhibitor Dermatologic: Not well estab- Psoriasis  PO Before starting: C Common: Diarrhea, GI side effects
(Otezla)  Psoriasis lished. Initial: 10mg, then None indi- nausea, vomiting, often improve
Selectively  ?Alopecia titrate up by addi- cated. weight loss, HA, back after first few
inhibits PDE- areata tional 10mg per pain, fatigue, insomnia, weeks of treat-
4, increasing Other day until day 6 Interval URI. ment.
intracellular  PsA Maintenance: 30 Monitoring:
cAMP, which mg BID None indi- Use with caution in
decreases cated. patients with depres-
inflamma- If CrCl <30, start sion, suicidal ideation,
tory TNF-α 10mg daily x 3 or if CrCl <30.
and IL-23, and days, then 20mg
increases anti- daily x 2 days, then
inflammatory 30mg daily.
IL-10.

Anakinra IL-1 Receptor Dermatologic:  Urticarial Adult RA Dose  SubQ Before starting: B Common: Injection site Syringe contains
(Kineret) Inhibitor None lesions asso- 100 mg/daily. Baseline Cr, reaction, URI, HA, nau- latex.
ciated with CBC, TB. sea, vomiting, diarrhea,
Recombinant Schnitzler’s For CrCl <30, con- fever, rash, arthralgia, Avoid live vac-
form of human Other Syndrome sider q48h dosing. Interval abdominal pain, flu-like cines.
IL-1 receptor  RA  Periodic fever Monitoring: symptoms.
antagonist.  Neonatal syndromes Pediatric Dose: CBC and Cr Do not give con-
onset multi- 2mg/kg monthly x 3 Rare but Serious: currently with
system inflam- months, then Malignancy, neutro- other TNF- α
Emily C. Milam, matory disease
(NOMID)
q3 months. penia, & thrombocy-
topenia
modifiers.

MD, is a PGY-2 Efficacy may

dermatology Avoid in patients with wane due to
severe renal impair- development
resident at New York ment, active infections, of neutralizing
University School of asthma, or hypersensi- anti-chimeric
tivity to E. coli proteins. antibodies.
Medicine.

p. 1 • Winter 2017 www.aad.org/DIR

boards fodder
Dermatology Biologics Chart (cont.)
By Emily C. Milam, MD

DRUG CLASS & FDA OFF-LABEL DOSING ROUTE MONITORING PREG. SIDE EFFECTS/ NOTES
MECHANISM APPROVED USES IN CATEGORY ADVERSE EVENTS
INDICATIONS DERMATOLOGY

Brodalumab IL-17 Receptor Dermatologic: Not well estab- Psoriasis  SubQ Before starting: Not Common: Arthralgia, Avoid live vac-
(Siliq) Antagonist  Psoriasis lished. 210mg at Weeks Test for TB. known HA, fatigue, diarrhea, cines.
0, 1, and 2, fol- oropharyngeal pain,
Human mono- lowed by 210mg Interval nausea, myalgia, injec- Because of
clonal IgG2 q2 weeks Monitoring: tion site reactions, risk of suicidal
antibody that Annual TB neutropenia, and tinea behavior, it is
blocks IL-17 test. infections. only available
receptor A. through a
Rare But Serious: restricted pro-
Neutropenia. gram called Siliq
Risk Evaluation
Contraindications: & Mitigation
Crohn’s disease. Strategy (REMS).

Black Box Warnings:

1. Suicidal ideation and
behavior

Certolizumab TNF-α Inhibitor Dermatologic: Not well estab- PsA  Start SubQ Before starting: Not Common: URIs, UTIs; Avoid live vac-
Pegol None lished. 400mg at weeks 0, Test for TB known abdominal pain; HA; cines.
(Cimzia) Recombinant 2, and 4, followed and hepatitis nausea; rash; injection
humanized by 200mg every 2 B. Consider site reactions; allergic Lupus-like
pegylated Other weeks (or, some testing HIV reactions. syndromes and
antibody Fab’  RA do 400g monthly) and hepati- autoimmune
fragment that  Crohn’s dis- tis C. Rare But Serious: CHF; hepatitis can
binds to TNF- ease melanoma & NMSC; arise in patients
α. Selectively  PsA Interval uveitis; central demy- on TNF-α
neutralizes  AS Monitoring: elinating disorders; Inhibitors.
TNF-α but does Annual TB cytopenias; new-onset
not neutralize test. psoriasis (especially Efficacy may
lymphotoxin α palmoplantar pus- wane due to
(TNF-B). tulosis); cutaneous development
small vessel vasculitis; of neutralizing
eczematous eruptions; anti-chimeric
lichenoid dermatitis. antibodies.

Black Box Warnings: May interfere

1. Serious & fatal infec- with aPTT tests.
tions
2. Malignancy (lym-
phoma and other
malignancies)

Screen for: CHF,

demyelinating diseases

Dupilumab IL-4 receptor Dermatologic: Not well estab- Atopic dermatitis SubQ No baseline Not Common: Injection site Efficacy may
(Dupixent) Inhibitor  Atopic der- lished.  Initial dose of or routine known reactions, conjuncti- wane due to
matitis 600mg divided tests recom- vitis, HSV outbreak, development
Binds to and into 2 sites, then mended. dry eyes. of neutralizing
inhibits the 300mg q2 weeks. antibodies.
alpha subunit Consider Rare But Serious:
of the IL-4 CBC with diff Keratitis, serum
receptor, which q6 months. sickness-like reac-
interferes with tion, hypersensitivity
IL-4 and IL-13 reaction.
cytokines.
Use with caution in
patients with asthma
or possible helminth
infection.

Efalizumab Inhibits activa- Dermatologic:  Granuloma Psoriasis  Initial SubQ Before starting: C Common: HA, fever, Withdrawn from
(Raptiva) tion and migra-  Psoriasis annulare dose of 0.7 mg/kg CBC and nausea, vomiting, USA market due
tion of T cells.  Cutaneous as a conditioning LFTs. myalgias. to PML risk in
lupus dose, followed in 1 patients receiv-
Recombinant,  Cutaneous week with 1 mg/kg Interval Rare But Serious: PML, ing long-term
humanized, dermatomyositis weekly (Max: 200 Monitoring: hemolytic anemia, therapy.
monoclonal  Atopic der- mg/dose) CBC (monitor thrombocytopenia,
IgG1 antibody. matitis platelets). infections, NMSC. Avoid live
Binds to CD11a  Alopecia vaccines.
of α-subunit of areata
T cell marker
leukocyte func-
tion-associated
antigen (LFA)-
1, preventing
it from binding
to intercellular
adhesion mol-
ecule 1.

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boards fodder
Dermatology Biologics Chart (cont.)
By Emily C. Milam, MD

DRUG CLASS & FDA APPROVED OFF-LABEL USES DOSING ROUTE MONITORING PREG. SIDE EFFECTS/ NOTES
MECHANISM INDICATIONS IN DERMATOLOGY CATEGORY ADVERSE EVENTS

Etanercept TNF-α Inhibitor Dermatologic:  Pediatric psoriasis Psoriasis  SubQ Before starting: B Common: injection site Syringe contains
(Enbrel)  Adult plaque  PG FDA Dosing: Test for TB. reactions, URI, diar- latex.
Dimeric fusion psoriasis  Behcet’s disease Initial dose of Consider rhea, rash, pruritus,
protein w/  Aphtous stomatitis 50mg twice weekly testing for fever, urticarial. Avoid live vac-
extracellular  Other neutrophilic x 3 months, fol- hepatitis B/C cines.
ligand-bonding Other: dermatoses lowed by 50mg and HIV. Rare But Serious: CHF;
portion of  PsA  Subcorneal pustu- once weekly. melanoma & NMSC; Lupus-like
human TNF  RA lar dermatoses Interval uveitis; central demy- syndromes
receptor linked  JIA  HS Recommended Monitoring: elinating disorders; and autoim-
to the Fc por-  AS  GVHD dose for pediatric Annual TB cytopenias; new-onset mune hepatitis
tion of IgG1.  Severe SCLE psoriasis is 0.8mg/ Test. psoriasis (especially can arise in
Inhibits binding  Autoimmune bul- kg weekly (maxi- Routine palmoplantar pus- patients on
of TNF-α and lous disease mum of 50mg). TBSE. tulosis); cutaneous TNF-α Inhibitors.
TNF-B to cell  Lichen planus small vessel vasculitis; However, some
surface TNF  Dermatomyositis eczematous eruptions; case reports
receptors,  Sarcoidosis lichenoid dermatitis. show improve-
rendering TNF  SAPHO syndrome ment in SCLE
biologically  Scleroderma Black Box Warnings: with etanercept.
inactive.  Generalized GA 1. Serious and fatal
 MRH infections Okay to use in
2. Lymphoma and other conjunction with
malignancies MTX and UV
therapy.
Screen for: CHF, IBD,
demyelinating diseases Avoid concurrent
administration
with IL-1 recep-
tor antagonists
(ie Anakinra).

Golimumab TNF-α Inhibitor Dermatologic: Not well estab- PsA, RA, AS  SubQ Before starting: Not Common: URI, injec- Syringe contains
(Simponi) None lished. 50mg monthly Test for TB known tion site reaction, HSV latex.
and hepatitis outbreak, ALT/ALT
Fully human- B. Consider elevation, HTN, rash, Avoid live vac-
ized recom- Other: testing for fever, dizziness, pares- cines.
binant IgG1k  PsA hepatitis C thesias.
monoclonal  RA and HIV. Lupus-like
antibody that  AS Rare But Serious: CHF; syndromes and
binds to both  UC Interval melanoma & NMSC; autoimmune
the soluble and Monitoring: uveitis; central demy- hepatitis can
transmem- Annual TB elinating disorders; arise in patients
brane bioac- Test. cytopenias; new-onset on TNF-α
tive forms of Routine psoriasis (especially Inhibitors.
human TNF-α. TBSE. palmoplantar pus-
tulosis); cutaneous Okay to admin-
small vessel vasculitis; ister alongside
eczematous eruptions; MTX.
lichenoid dermatitis.

Black Box Warnings:

1. Serious and fatal
infections
2. Lymphoma and other
malignancies

Screen for: CHF,

demyelinating diseases

Guselkumab IL-23 Inhibitor Dermatologic: Not well estab- Psoriasis  SubQ Before starting: Not Common: URI, HA, Avoid live vac-
(Tremfya)  Psoriasis lished. 100mg at Week 0, Test for TB. known injection site reactions, cines.
Recombinant Week 4, then q8 arthralgia, diarrhea,
humanized weeks thereafter Interval gastroenteritis, tinea,
monoclonal Monitoring: HSV, elevated liver
Ab; Annual TB enzymes.
Selectively test.
blocks IL-23
(but not IL-12)

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boards fodder
Dermatology Biologics Chart (cont.)
By Emily C. Milam, MD

DRUG CLASS & FDA APPROVED OFF-LABEL USES DOSING ROUTE MONITORING PREG. SIDE EFFECTS/ NOTES
MECHANISM INDICATIONS IN DERMATOLOGY CATEGORY ADVERSE EVENTS

Infliximab TNF-α Inhibitor Dermatologic:  PG Psoriasis 5mg/ IV Before starting: B Common: Infusion- Lupus-like
(Remicade)  Psoriasis  Bechet’s disease kg given as an IV Test for TB. related reactions, syndromes and
Chimeric  Granulomatous induction regi- Consider including fever, chills, autoimmune
(human- cheilitis men at 0, 2, and testing for pruritus, hypo- or hepatitis can
mouse) IgG1k Other:  Vasculitides 6 weeks, followed hepatitis B/C hypertension, chest arise in patients
monoclonal  PsA  PRP by maintenance and HIV. pain, urticaria, short- on TNF-α inhibi-
antibody  Adult & pedi-  Reactive arthritis regimen of 5 mg/ ness of breath, and tors.
specific for atric Crohn’s  Subcorneal pus- kg every 8 wks Interval (rarely) anaphylaxis;
human TNF-α.  UC tular dermatoses thereafter. Monitoring: URI, nausea, headache, Avoid live vac-
Neutralizes  RA  HS Annual TB abdominal pain, rash, cines.
the biologi-  AS  GVHD Test. dyspepsia, arthralgia,
cal activity of  Sjogren’s Doses ranging Routine pruritus, fever, HTN. Efficacy may
TNF-α by  SLE from 3-10 mg/kg TBSE. decrease over
binding w/ high  Dermatomyositis have been used. Rare But Serious: CHF; time due to
affinity to the  Scleroderma melanoma & NMSC; development
soluble and  Sarcoidosis Infusion should be hepatotoxicity; uveitis; of neutralizing
transmem-  Granuloma administered over central demyelinat- anti-chimeric
brane forms of annulare 2 or more hours. ing disorders; allergic antibodies.
TNF-α, inhibit-  MRH reactions; serum-sick- Concurrent use
ing it from  Pemphigus ness; cytopenias; new- of low-dose
binding w/ its vulgaris onset psoriasis (espe- weekly MTX may
receptors.  SAPHO syn- cially palmoplantar help prevent
drome pustulosis); cutaneous antibody forma-
 TEN small vessel vasculitis; tion.
eczematous eruptions;
lichenoid dermatitis. Avoid concurrent
administration
Contraindications: with IL-1 recep-
- Allergy to murine tor antagonists
proteins (ie Anakinra).

Black Box Warnings:

1. Serious & fatal infec-
tions
2. Malignancy (lym-
phoma and other
malignancies)

Screen for: CHF, demy-

elinating diseases

Ixekizumab IL-17 Inhibitor Dermatologic: Not well estab- Psoriasis Initial SubQ Before starting: Not Common: Injection site Avoid live
(Taltz)  Psoriasis lished. dose of 160mg Test for TB. known reactions, URI, nausea, vaccines.
Humanized once, then 80mg tinea infections.
IL-17A antago- q2 weeks x 12 Interval Efficacy may
nist, inhibiting weeks, then 80mg Monitoring: Rare But Serious: New wane due to
release of q4 weeks. Annual TB or exacerbated cases development
associated test. of IBD; hypersensitivity of neutralizing
inflammatory reaction, neutropenia; antibodies.
cytokines and thrombocytopenia.
chemokines.
Screen for: IBD.

Omalizumab IgE Inhibitor Dermatologic:  Atopic dermatitis  Chronic SubQ Before starting: B Common: Injection site Live virus vac-
(Xolair)  Chronic idio- urticaria Serum total reactions, arthritis, cines should be
Humanized pathic urticaria 150-375mg q2-4 IgE levels rash, fever, pruritus, given cautiously
recombinant weeks (Max of URIs. during omali-
monoclonal 150mg per injec- zumab treatment
antibody (IgG1). Other: tion site) Rare But Serious: until more data
Blocks IgE’s  Asthma Anaphylaxis and malig- are available.
high affinity Doses calculated nancy.
Fc receptor, based on body
decreasing IgE weight and base- Black Box Warnings:
and blocking line serum total 1. Anaphylaxis after
its attachment IgE levels. first dose, and even
to mast cells, after >1 year of treat-
basophils, and ment
dendritic cells.

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boards fodder
Dermatology Biologics Chart (cont.)
By Emily C. Milam, MD

DRUG CLASS & FDA OFF-LABEL USES DOSING ROUTE MONITORING PREG. SIDE EFFECTS/ NOTES
MECHANISM APPROVED IN DERMATOLOGY CATEGORY ADVERSE EVENTS
INDICATIONS

Rituximab CD20 Inhibitor Dermatologic:  Cutaneous Doses vary widely IV Before starting: C Severe infusion Useful in B-cell
(Rituxan) None B-cell lymphoma by indication. Test for hep- reactions can occur mediated skin
 Autoimmune atitis B and (typically with the first diseases.
Chimeric Other: bullous derma- TB. Consider infusion).
monoclonal  RA toses (pemphi- testing hepa- Cases of PML
antibody that  non-Hodgkin gus vulgaris, titis C, CBC. Serious infections have been
binds to CD20 B-cell lymphoma bullous pemphi- (bacterial, fungal, and reported.
antigen found  CLL goid, paraneo- Interval viral) can occur up to 1
on surface of Granulomatosis plastic pemphi- Monitoring: year after completing Tumor lysis syn-
mature B cells with Polyangiitis gus, EBA) Consider therapy, or reactiva- drome can occur
and causes ( (Wegener’s)  SLE annual TB tion of viral infections in lymphoma
apoptosis of and Microscopic  Cutaneous and semi- (especially hepatitis B). patients.
these cells Polyangiitis (MPA) lupus frequent
or existing  CBCs. Reported cases of Efficacy may
plasma cells. Dermatomyositis bowel obstruction decrease over
 Chronic GVHD and perforation, car- time due to
 Vasculitis diac arrhythmias and development
 Other B-cell- angina, SJS/TEN, and of neutralizing
mediated auto- onset of paraneoplastic anti-chimeric
immune and pemphigus. antibodies.
inflammatory
diseases Contraindications: Patients should
Hypersensitivity to be counseled to
murine proteins; seri- avoid live vacci-
ous infections. Take nations while on
precaution in patients medication.
with history of angio-
edema or hypotension. IV methylpredni-
sone 100mg typi-
Black Box Warnings: cally given prior
1. Serious or fatal infu- to infusion.
sion reactions
2. Severe mucocutane-
ous reactions (i.e. SJS/
TEN, paraneoplastic
pemphigus).
3. HBV Reactivation
4. PML

Secukinumab IL-17 Inhibitor Dermatologic: Psoriasis  300 Psoriasis  SubQ Before starting: B Common: URIs, diar- Syringe contains
(Cosentyx)  Psoriasis mg subcutane- Initial dose 150mg Test for TB. rhea. latex.
Human IgG1 ously at weeks 0, weekly x 5 weeks,
monoclonal 1, 2, 3, and 4 fol- followed by 150mg Interval Rare But Serious: Avoid live vac-
antibody Other: lowed by 300 mg q4 weeks. Monitoring: Anaphylactic or hyper- cines.
that binds to  PsA every 4 weeks. Annual TB sensitivity reactions,
IL-17A, inhibit-  AS Can consider test neutropenia, severe Efficacy may
ing release 150 mg may be increasing dose infections. decrease over
of associated acceptable for to 300mg q4 week time due to
inflammatory some patients. if active disease Use with caution if development
cytokines and persists. history of IBD. of neutralizing
chemokines. anti-chimeric
antibodies.

Tofacitinib JAK3 Inhibitor Dermatologic:  ?Alopecia RA  5mg BID PO Before starting: C Common: URI, UTI, Avoid live vac-
(Xeljanz) None areata Test for TB, HA, diarrhea, ALT/AST cines.
Inhibits JAKs, CBC, CMP, increase, Cr increase,
intracellular Consider dose and lipids. cholesterol increase, Okay to use with
enzymes that Other: decreased to 5mg transient lymphocy- MTX. Do not
transmit sig-  RA daily in severe tosis. use in combina-
nals arising hepatic or renal Interval tion with other
from cytokine impairment. Monitoring: Rare But Serious: biologics or
or growth fac- CBC at 4 and Increased risk of infec- immunosuppres-
tor receptor 8 weeks, then tions, NMSC, pancyto- sants.
interactions, q3 months. penia, GI perforation.
decreasing Lipids 4-6
downstream weeks after Tofacitinib is not rec-
interferons, starting. ommended for patients
interleukins, & Periodic CMP. with severe hepatic or
erythropoietin. renal impairment.

Black Box Warnings:

1. Serious & fatal
infections (including
new TB or reactivation)
2. Lymphoma and other
malignancies

p. 5 • Winter 2017 www.aad.org/DIR

boards fodder
Dermatology Biologics Chart (cont.)
By Emily C. Milam, MD

DRUG CLASS & FDA OFF-LABEL USES DOSING ROUTE MONITORING PREG. SIDE EFFECTS/ NOTES
MECHANISM APPROVED IN DERMATOLOGY CATEGORY ADVERSE EVENTS
INDICATIONS

Ustekinumab IL-12/IL-23 Dermatologic: Not well Psoriasis  SubQ Before starting: B Common: URIs, HA, Syringe contains
(Stelara) Inhibitor  Adult plaque established. For pts <100kg, Test for TB. injection site reaction, latex.
psoriasis 45mg initially and back pain, fatigue.
Human IgG1k 4 wks later, fol- Interval Avoid live
monoclonal lowed by 45mg Monitoring: Rare But Serious: vaccines.
antibody that Other: every 12 wks. Annual TB Possible increased risk
binds w/ high  PsA For pts >100kg, test of adverse cardiovas- Patients defi-
affinity and  Crohn’s recommend dose cular events, severe cient in IL-12/
specificity to disease is 90mg initially infections, NMSC, and IL-23 have
p40 protein and 4 wks later, malignancy. increased risk
subunit by both followed by 90mg of severe infec-
the IL-12 and every 12 wks. Pustular and erythro- tions with myco-
IL-23 cyto- dermic psoriasis cases bacteria and
kines. have been noted post- Salmonella.
marketing.

Abbreviations:
TNF = Tumor necrosis factor IBD = Inflammatory bowel disease SCLE = Subacute cutaneous lupus erythematous
HS = Hidradenitis suppurativa JIA = Juvenile idiopathic arthritis PDE = Phosphodiesterase
AS = Ankylosing spondylitis RA = Rheumatoid arthritis MRH = Multicentric reticulohistiocytosis
PsA = Psoriatic arthritis GVHD = Graft versus host disease PRP = Pityriasis rubra pilaris
TEN = Toxic epidermal necrolysis PG = Pyoderma gangrenosum

References:
1. Wolverton, S. Comprehensive Dermatologic Drug Therapy: Saunders Elsevier; 2013.
2. Bolognia J, Jorizzo J, Schaffer I. Dermatology. Philadelphia: Elsevier; 2012.
3. https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/125036s0144lbl.pdf
4. http://www.rxabbvie.com/pdf/humira.pdf
5. http://media.celgene.com/content/uploads/otezla-pi.pdf
6. http://www.kineretrx.com/pdf/Full-Prescribing-Information-English.pdf
7. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/761032lbl.pdf
8. https://www.cimzia.com/sites/default/files/docs/Prescribing_Information.pdf
9. https://www.regeneron.com/sites/default/files/Dupixent_FPI.pdf
10. https://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM143346.pdf
11. http://pi.amgen.com/~/media/amgen/repositorysites/pi-amgen-com/enbrel/enbrel_pi.pdf
12. https://www.simponi.com/shared/product/simponi/prescribing-information.pdf
13. https://www.tremfyahcp.com/pdf/PrescribingInformation.pdf
14. http://www.janssenlabels.com/package-insert/product-monograph/prescribing-information/REMICADE-pi.pdf
15. http://uspl.lilly.com/taltz/taltz.html#pi
16. https://www.gene.com/download/pdf/xolair_prescribing.pdf
17. https://www.gene.com/download/pdf/rituxan_prescribing.pdf
18. https://www.pharma.us.novartis.com/sites/www.pharma.us.novartis.com/files/cosentyx.pdf
19. http://labeling.pfizer.com/ShowLabeling.aspx?id=959
20. https://www.stelarahcp.com/sites/www.stelarahcp.com/files/prescribing-information-stelara.pdf?v=11
21. Ahn CS, Dothard EH, Garner ML, Feldman SR, Huang WW. To test or not to test? An updated evidence-based assessment of the value of screening and monitoring tests when
using systemic biologic agents to treat psoriasis and psoriatic arthritis. J Am Acad Dermatol. 2015;73(3):420-8.e1.

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