Immunobiologicals are now employed in current clinical practice to treat inflammatory diseases, especially in dermatology. They have been approved to be used for psoriasis, atopic dermatitis and hidradenitis suppurativa, along with many others undergoing study. Dermatologists need to remain updated regarding the medications approved in Brazil, for the best management of dermatoses. This also designates hope for improvement in patients with chronic diseases.

Immunobiologicals for psoriasis can be illustrated as:

• Etanercept with anti-TNF-α action, indicated in PSO (adults and children ≥8 years), RA, PA, AS and axial AS; can be given= I: 50 mg SC, 2× week for 12 weeks; M: 50 mg SC, 1× week (pediatric dose– 0.8 mg/kg (max. 50 mg) SC, 1× week).
• Infliximab with anti-TNF-α action, indicated in PSO, PA, RA, AS (adults); CD and RU (adults and ≥6 years); can be given= I: 5 mg/kg IV, weeks 0-2-6, M: 5 mg/kg IV 8/8 weeks.
• Adalimumab with anti-TNF-α action, indicated in PSO, PA, HS, RU, RA, AS, axial AS (adults); CD, Uveitis, JIA and ERA (adults and children ≥2 years); can be given= I: 80 mg D0, 40 mg D7, M: 40 mg every 14 days (par HS – I: 160 mg D0, 80 mg D14, 40 mg D28; M: 40 mg every 7 days).
• Certolizumab-pegol with anti-TNF-α action, indicated in PA, CD, RA and AS; can be given= I: 400 mg SC, weeks 0-2-4; M: 200 mg SC, every 2 weeks or 400 mg SC, every 4 weeks (Dose corresponding to psoriatic arthritis).
• Ustekinumab with anti-IL-12,23 action, indicated in PSO, PA, CD; can be given= I: 45 mg SC weeks 0-4; M: 45 mg SC every 12 weeks(In patients weighing more than 100 kg, the dose should be 90 mg; Pediatric used from 9 years of age on).
• Secukinumab with anti-IL-17 action, indicated in PSO, PA and AS; can be given= I: 300 mg SC, weeks 0-1-2-3-4; M: 300 mg SC every 4 weeks.
• Ixekizumab with anti-IL-17 action, indicated in PSO; can be given= I: 160 mg SC weeks 0, 80 mg weeks 2-4-6-8-10-12; M: 80 mg SC every 4 weeks.
• Guselkumab with anti-IL-23 action, indicated in PSO, PA; can be given= I: 100 mg SC weeks 0-4; M: 100 mg SC every 8 weeks.
• Risankizumab with anti-IL-23 action, indicated in PSO; can be given = I: 150 mg SC weeks 0-4; M: 150 mg SC every 12 weeks.

Other biological medications are:

• Omalizumab with anti-IgE action, indicated in CSU, allergic asthma; given 300 mg SC every 4 weeks.
• Dupilumab with anti-IL-4, IL-13 action, indicated in moderate-to-severe AD; can be given = I: 600 mg SC, without 0, M: 300 mg SC, every 2 weeks.
• Rituximab with anti-B lymphocytes action, indicated in moderate-to-severe PV, RA, leukemia, lymphomas, vasculitis; can be given as= 2 doses of 1000 mg with a 14-day interval (Dose recommended for RA).

[Where plaque psoriasis (PSO), hidradenitis suppurativa (HS), multiple sclerosis (MS), heart failure (HF), rheumatoid arthritis (RA), psoriatic arthritis (PA), Crohns disease (CD), atopic dermatitis (AD), pemphigus vulgaris (PV)].

Source: da Silva DLF, Secamilli EN, Beleli MV, et al. Immunobiologicals in dermatology. An Bras Dermatol. 2022 Mar 18:S0365-0596(22)00032-0.