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Advancing Knowledge. Enhancing Care.

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EADV 2020 | The Use of Biologics in Children

Biologics, Pediatric 2020 October

Presented by Beatrix Volc-Platzer, MD

A report from the 29th Congress of the European Academy of Dermatology and Venereology


To date, our experience and data of biologics comes largely from the adult population. For psoriasis, there are currently four biologics approved for pediatric use: etanercept (6+ years), adalimumab (4+ years), ustekinumab (12+ years) and secukinumab (6+ years).

Overall, biologics overall appear effective and safe in pediatric psoriasis. Real-world data of anti-TNF agents in children found injection site reactions in roughly 27% and infections in roughly 11%, but notably few severe adverse events overall and none with ustekinumab.1-3

Children metabolize medications, including biologics, differently and often require a relatively higher dose; drug troughs can ensure safety and efficacy.4 Pediatric drug survival is also important. A study evaluating real-life conditions found drug survival is significantly highest for ustekinumab (versus adalimumab and etanercept) across all treatment groups and psoriasis types, and across 8 years approximately 60% of children remained on ustekinumab.

Other considerations in pediatric psoriasis includes biologic effect on comorbidities, immunogenicity, vaccinations, and currently, COVID-19 risk. To date, no reliable data exists on therapeutic effects to comorbidities in the pediatric population,5,6  and immunogenicity has not been studied extensively.7  Though often not an issue in adults, live vaccines are strictly contraindicated and therefore must be completed prior to biologic initiation in children.8-9  Fortunately, thus far biologics do not appear to increase risk of poor COVID-19 outcomes, though evolving data should continue to be analyzed carefully.



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