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Dermatology

Systemic Immunomodulators

Built from Dermatology, 5th Edition

What’s inside

13 sections · 166 slides

  1. 01

    Overview

    • What this chapter covers

    1 slide

  2. 02

    Interferons

    Proteins the body makes to fight viruses, borrowed as injectable therapy

    • What interferons are
    • Injection-site skin damage
    • How interferons work inside cells
    • Mechanisms of action for interferons.
    • Approved dermatologic uses
    • Interferons.
    • Dermatologic uses, side effects, and interactions of interferons.
    • Dermatologic uses, side effects, and interactions of interferons. (continued)
    • Dermatologic uses, side effects, and interactions of interferons. (continued)
    • Dermatologic uses, side effects, and interactions of interferons. (continued)
    • A drug side effect that mimics disease
    • Colony-stimulating factors: GM-CSF and G-CSF
    • Granulocyte–macrophage and granulocyte colony stimulating factors (GM-CSF &G-CSF).
    • Granulocyte–macrophage and granulocyte colony stimulating factors (GM-CSF &G-CSF). (continued)
    • Granulocyte–macrophage and granulocyte colony stimulating factors (GM-CSF &G-CSF). (continued)
    • Granulocyte–macrophage and granulocyte colony stimulating factors (GM-CSF &G-CSF). (continued)
    • Injection-site reaction to GM-CSF

    17 slides

  3. 03

    Targeted Immune Modulators

    Drugs engineered to block one specific protein driving skin disease

    • What targeted immune modulators are
    • How antibody drug names are built
    • Nomenclature for monoclonal antibodies and fusion proteins.
    • Sites of action of targeted immune modulators
    • Screening before starting therapy
    • Recommended evaluation for patients receiving targeted immune modulators for dermatologic disorders.
    • Recommended laboratory testing before and during treatment
    • Why hepatitis screening matters
    • Hepatitis B and C serologic test interpretation
    • US Food and Drug Administration (FDA) warnings and precautions for targeted immune modulators with dermatologic indications.
    • US Food and Drug Administration (FDA) warnings and precautions for targeted immune modulators with dermatologic indications. (continued)
    • US Food and Drug Administration (FDA) warnings and precautions for targeted immune modulators with dermatologic indications. (continued)
    • US Food and Drug Administration (FDA) warnings and precautions for targeted immune modulators with dermatologic indications. (continued)
    • US Food and Drug Administration (FDA) warnings and precautions for targeted immune modulators with dermatologic indications. (continued)

    14 slides

  4. 04

    TNF Inhibitors

    Etanercept, infliximab, adalimumab, golimumab, certolizumab pegol

    • What TNF is and why it is targeted
    • Mechanism of action of the TNF inhibitors
    • How the five TNF inhibitors differ
    • Who should not receive TNF inhibitors
    • FDA warnings across all targeted immune modulators
    • Infection risk with TNF inhibitors
    • Cancer risk with TNF inhibitors
    • Autoimmunity, nerve, and heart effects
    • Etanercept clearing a lupus skin rash
    • Skin reactions caused by TNF inhibitors
    • Psoriasiform reactions to TNF inhibitors
    • Cutaneous side effects of targeted immune modulators.
    • Cutaneous side effects of targeted immune modulators. (continued)
    • Cutaneous side effects of targeted immune modulators. (continued)
    • Vaccination and TNF inhibitors
    • Vaccines that contain live attenuated viruses or bacteria.
    • TNF inhibitors in pregnancy
    • Etanercept
    • Etanercept injection-site reaction
    • Infliximab
    • Adalimumab
    • Golimumab and certolizumab pegol
    • Biosimilars of TNF inhibitors
    • Examples of biosimilars of monoclonal antibodies used in dermatology
    • Examples of biosimilars of monoclonal antibodies used in dermatology (continued)
    • Examples of biosimilars of monoclonal antibodies used in dermatology (continued)

    26 slides

  5. 05

    Interleukin-12/23 and Interleukin-23 Inhibitors

    Ustekinumab, guselkumab, risankizumab, tildrakizumab

    • IL-12 and IL-23: two related cytokines
    • Sites of action of IL-12/23 and IL-23 inhibitors
    • Safety of IL-12/23 and IL-23 inhibitors
    • Ustekinumab
    • Guselkumab, tildrakizumab, and risankizumab

    5 slides

  6. 06

    Interleukin-17 Inhibitors

    Secukinumab, ixekizumab, brodalumab - plus spesolimab for IL-36

    • Why block interleukin-17
    • Sites of action of IL-17 inhibitors
    • Safety shared across IL-17 inhibitors
    • Ixekizumab and secukinumab
    • Brodalumab: efficacy and a safety warning
    • Spesolimab: a different target, IL-36

    6 slides

  7. 07

    Interleukin-4/13 Receptor and Interleukin-13 Inhibitors

    Dupilumab, tralokinumab, and lebrikizumab for atopic dermatitis

    • IL-4 and IL-13: the atopic dermatitis cytokines
    • Sites of action of IL-4/13 receptor and IL-13 inhibitors
    • Shared side effect: the eye problem
    • A severe example: ectropion
    • Conjunctivitis and ectropion on dupilumab therapy
    • Dupilumab
    • Tralokinumab

    7 slides

  8. 08

    Interleukin-1 Inhibitors

    Anakinra, canakinumab, and rilonacept for autoinflammatory disease

    • IL-1 and the inflammasome
    • Shared safety of IL-1 blockers
    • Anakinra
    • Canakinumab and rilonacept

    4 slides

  9. 09

    Rituximab

    An antibody that removes CD20-positive B cells

    • Rituximab: removing the B cells
    • What rituximab treats
    • Rituximab risks

    3 slides

  10. 10

    Omalizumab

    An anti-IgE antibody for chronic hives

    • Omalizumab: blocking IgE
    • Omalizumab dosing and safety

    2 slides

  11. 11

    Janus Kinase (JAK) Inhibitors

    Oral pills that block cytokine signaling one step inside the cell

    • Janus kinases: one step inside the cell
    • Mechanism of action of Janus kinase (JAK) inhibitors
    • The seven approved JAK inhibitors
    • Who should avoid JAK inhibitors
    • JAK inhibitor side effects
    • Abrocitinib and baricitinib
    • Deucravacitinib and ritlecitinib
    • Ruxolitinib, tofacitinib, and upadacitinib

    8 slides

  12. 12

    Under Investigation and Other Targeted Therapies

    The biologic-drug pipeline reaches far beyond dermatology

    • The pipeline keeps growing
    • Targeted immune modulators for psoriasis under development.
    • Targeted immune modulators for psoriasis under development. (continued)
    • Other biologic agents used across medicine
    • Other targeted (“biologic”) agents used in medicine.
    • Other targeted (“biologic”) agents used in medicine. (continued)
    • Other targeted (“biologic”) agents used in medicine. (continued)
    • Other targeted (“biologic”) agents used in medicine. (continued)
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    48 slides

  13. 13

    Intravenous Immune Globulin (IVIg)

    Pooled donor antibody used for a short list of skin diseases

    • What IVIg is
    • How IVIg calms the immune system
    • What IVIg treats in dermatology
    • Uses of IVIg in dermatology.
    • Uses of IVIg in dermatology. (continued)
    • Uses of IVIg in dermatology. (continued)
    • Choosing an IVIg product
    • Selected preparations of IVIg that are available in the US.
    • IVIg safety and contraindications
    • Putting it together
    • Each drug class, and its lead skin target
    • References
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    • Dermatology, 5th Edition (2-Volume Set)

    25 slides