Skip to main content

Immunogenicity of Biologic Treatments for Psoriasis: Therapeutic Consequences and the Potential Value of Concomitant Methotrexate

American Journal of Clinical Dermatology volume 16, pages 285–294 (2015)Cite this article

Abstract

The five biologic agents approved for the treatment of psoriasis—etanercept, infliximab, adalimumab, ustekinumab, and secukinumab—have been transformative in the clinical management of severe forms of the disease. However, a significant number of patients fail to respond to these agents or experience a loss of efficacy over time, which may be attributable to the development of antidrug antibodies (ADAs). Increasing evidence, primarily in the context of rheumatoid arthritis or other chronic inflammatory diseases, suggests that concomitant administration of methotrexate may prevent or diminish the development of ADAs, thereby improving response rates. However, methotrexate is infrequently coadministered with biologic agents in patients with psoriasis, and the potential benefits of this strategy in the context of psoriasis are largely unexplored. In this review, we discuss clinical studies regarding the development and consequences of antibodies targeting biologic agents used in the treatment of psoriasis and present key findings describing the potential role of methotrexate as an inhibitor of immunogenicity. We also discuss clinical considerations pertaining to the use of methotrexate as a tool to reduce immunogenicity, and encourage further investigation into potential techniques to optimize this treatment approach in patients with psoriasis.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 49.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Cosentyx [package insert]. East Hanover (NJ): Novartis Pharmaceuticals Corporation; 2015.

  2. Remicade [package insert]. Horsham (PA): Janssen Biotech, Inc; 2013.

  3. Humira [package insert]. North Chicago (IL): AbbVie Inc; 2014.

  4. Enbrel [package insert]. Thousand Oaks (CA): Amgen Inc; 2013.

  5. Stelara [package insert]. Horsham (PA): Janssen Biotech, Inc; 2014.

  6. American Academy of Dermatology Work Group, Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol. 2011;65(1):137–74.

    Article  Google Scholar 

  7. Jullien D, Prinz JC, Nestle FO. Immunogenicity of biotherapy used in psoriasis: the science behind the scenes. J Invest Dermatol. 2015;135(1):31–8.

    Article  PubMed  Google Scholar 

  8. Gottlieb AB, Evans R, Li S, Dooley LT, Guzzo CA, Baker D, et al. Infliximab induction therapy for patients with severe plaque-type psoriasis: a randomized, double-blind, placebo-controlled trial. J Am Acad Dermatol. 2004;51(4):534–42.

    Article  PubMed  Google Scholar 

  9. Menter A, Feldman SR, Weinstein GD, Papp K, Evans R, Guzzo C, et al. A randomized comparison of continuous vs. intermittent infliximab maintenance regimens over 1 year in the treatment of moderate-to-severe plaque psoriasis. J Am Acad Dermatol. 2007;56(1):31.e1-15.

  10. Asahina A, Nakagawa H, Etoh T, Ohtsuki M, Adalimumab MSG. Adalimumab in Japanese patients with moderate to severe chronic plaque psoriasis: efficacy and safety results from a phase II/III randomized controlled study. J Dermatol. 2010;37(4):299–310.

    Article  CAS  PubMed  Google Scholar 

  11. Blauvelt A, Prinz JC, Gottlieb AB, Kingo K, Sofen H, Ruer-Mulard M, et al. Secukinumab administration by pre-filled syringe: efficacy, safety and usability results from a randomized controlled trial in psoriasis (FEATURE). Br J Dermatol. 2015;172(2):484–93.

    Article  CAS  PubMed  Google Scholar 

  12. Carrascosa JM. Immunogenicity in biologic therapy: implications for dermatology. Actas Dermosifiliogr. 2013;104(6):471–9.

    Article  CAS  PubMed  Google Scholar 

  13. De Simone C, Amerio P, Amoruso G, Bardazzi F, Campanati A, Conti A, et al. Immunogenicity of anti-TNF alpha therapy in psoriasis: a clinical issue? Expert Opin Biol Ther. 2013;13(12):1673–82.

    Article  PubMed  Google Scholar 

  14. Gniadecki R, Bang B, Bryld LE, Iversen L, Lasthein S, Skov L. Comparison of long-term drug survival and safety of biologic agents in patients with psoriasis vulgaris. Br J Dermatol. 2015;172(1):244–52.

    Article  CAS  PubMed  Google Scholar 

  15. Gottlieb AB, Kalb RE, Blauvelt A, Heffernan MP, Sofen HL, Ferris LK, et al. The efficacy and safety of infliximab in patients with plaque psoriasis who had an inadequate response to etanercept: results of a prospective, multicenter, open-label study. J Am Acad Dermatol. 2012;67(4):642–50.

    Article  CAS  PubMed  Google Scholar 

  16. Hsu L, Snodgrass BT, Armstrong AW. Antidrug antibodies in psoriasis: a systematic review. Br J Dermatol. 2014;170(2):261–73.

    Article  CAS  PubMed  Google Scholar 

  17. Krathen RA, Berthelot CN, Hsu S. Sustained efficacy and safety of infliximab in psoriasis: a retrospective study of 73 patients. J Drugs Dermatol. 2006;5(3):251–4.

    PubMed  Google Scholar 

  18. Langley RG, Elewski BE, Lebwohl M, Reich K, Griffiths CE, Papp K, et al. Secukinumab in plaque psoriasis: results of two phase 3 trials. N Engl J Med. 2014;371(4):326–38.

    Article  PubMed  Google Scholar 

  19. Papp KA, Tyring S, Lahfa M, Prinz J, Griffiths CE, Nakanishi AM, et al. A global phase III randomized controlled trial of etanercept in psoriasis: safety, efficacy, and effect of dose reduction. Br J Dermatol. 2005;152(6):1304–12.

    Article  CAS  PubMed  Google Scholar 

  20. Reich K, Nestle FO, Papp K, Ortonne JP, Evans R, Guzzo C, et al. Infliximab induction and maintenance therapy for moderate-to-severe psoriasis: a phase III, multicentre, double-blind trial. Lancet. 2005;366(9494):1367–74.

    Article  CAS  PubMed  Google Scholar 

  21. Takahashi H, Tsuji H, Ishida-Yamamoto A, Iizuka H. Plasma trough levels of adalimumab and infliximab in terms of clinical efficacy during the treatment of psoriasis. J Dermatol. 2013;40(1):39–42.

    Article  CAS  PubMed  Google Scholar 

  22. Torii H, Nakagawa H. Japanese Infliximab Study Investigators. Infliximab monotherapy in Japanese patients with moderate-to-severe plaque psoriasis and psoriatic arthritis: a randomized, double-blind, placebo-controlled multicenter trial. J Dermatol Sci. 2010;59(1):40–9.

    Article  CAS  PubMed  Google Scholar 

  23. Tsai TF, Ho JC, Song M, Szapary P, Guzzo C, Shen YK, et al. Efficacy and safety of ustekinumab for the treatment of moderate-to-severe psoriasis: a phase III, randomized, placebo-controlled trial in Taiwanese and Korean patients (PEARL). J Dermatol Sci. 2011;63(3):154–63.

    Article  CAS  PubMed  Google Scholar 

  24. Vincent FB, Morand EF, Murphy K, Mackay F, Mariette X, Marcelli C. Antidrug antibodies (ADAb) to tumour necrosis factor (TNF)-specific neutralising agents in chronic inflammatory diseases: a real issue, a clinical perspective. Ann Rheum Dis. 2013;72(2):165–78.

    Article  CAS  PubMed  Google Scholar 

  25. Bartelds GM, Wijbrandts CA, Nurmohamed MT, Stapel S, Lems WF, Aarden L, et al. Anti-infliximab and anti-adalimumab antibodies in relation to response to adalimumab in infliximab switchers and anti-tumour necrosis factor naive patients: a cohort study. Ann Rheum Dis. 2010;69(5):817–21.

    Article  CAS  PubMed  Google Scholar 

  26. Krieckaert CL, Nurmohamed MT, Wolbink GJ. Methotrexate reduces immunogenicity in adalimumab treated rheumatoid arthritis patients in a dose dependent manner. Ann Rheum Dis. 2012;71(11):1914–5.

    Article  CAS  PubMed  Google Scholar 

  27. Maini RN, Breedveld FC, Kalden JR, Smolen JS, Davis D, Macfarlane JD, et al. Therapeutic efficacy of multiple intravenous infusions of anti-tumor necrosis factor alpha monoclonal antibody combined with low-dose weekly methotrexate in rheumatoid arthritis. Arthritis Rheum. 1998;41(9):1552–63.

    Article  CAS  PubMed  Google Scholar 

  28. Jani M, Barton A, Warren RB, Griffiths CE, Chinoy H. The role of DMARDs in reducing the immunogenicity of TNF inhibitors in chronic inflammatory diseases. Rheumatology (Oxford). 2014;53(2):213–22.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Krieckaert CL, Bartelds GM, Lems WF, Wolbink GJ. The effect of immunomodulators on the immunogenicity of TNF-blocking therapeutic monoclonal antibodies: a review. Arthritis Res Ther. 2010;12(5):217.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Bartelds GM, Krieckaert CL, Nurmohamed MT, van Schouwenburg PA, Lems WF, Twisk JW, et al. Development of antidrug antibodies against adalimumab and association with disease activity and treatment failure during long-term follow-up. JAMA. 2011;305(14):1460–8.

    Article  CAS  PubMed  Google Scholar 

  31. Lecluse LL, Driessen RJ, Spuls PI, de Jong EM, Stapel SO, van Doorn MB, et al. Extent and clinical consequences of antibody formation against adalimumab in patients with plaque psoriasis. Arch Dermatol. 2010;146(2):127–32.

    Article  CAS  PubMed  Google Scholar 

  32. Baert F, Noman M, Vermeire S, Van Assche G, D'Haens G, Carbonez A, et al. Influence of immunogenicity on the long-term efficacy of infliximab in Crohn’s disease. N Engl J Med. 2003;348(7):601–8.

    Article  CAS  PubMed  Google Scholar 

  33. Hanauer SB, Wagner CL, Bala M, Mayer L, Travers S, Diamond RH, et al. Incidence and importance of antibody responses to infliximab after maintenance or episodic treatment in Crohn’s disease. Clin Gastroenterol Hepatol. 2004;2(7):542–53.

    Article  CAS  PubMed  Google Scholar 

  34. Karmiris K, Paintaud G, Noman M, Magdelaine-Beuzelin C, Ferrante M, Degenne D, et al. Influence of trough serum levels and immunogenicity on long-term outcome of adalimumab therapy in Crohn’s disease. Gastroenterology. 2009;137(5):1628–40.

    Article  CAS  PubMed  Google Scholar 

  35. Rutgeerts P, Feagan BG, Lichtenstein GR, Mayer LF, Schreiber S, Colombel JF, et al. Comparison of scheduled and episodic treatment strategies of infliximab in Crohn’s disease. Gastroenterology. 2004;126(2):402–13.

    Article  CAS  PubMed  Google Scholar 

  36. Sokka T, Kautiainen H, Toloza S, Makinen H, Verstappen SM, Lund Hetland M, et al. QUEST-RA: quantitative clinical assessment of patients with rheumatoid arthritis seen in standard rheumatology care in 15 countries. Ann Rheum Dis. 2007;66(11):1491–6.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Singh JA, Furst DE, Bharat A, Curtis JR, Kavanaugh AF, Kremer JM, et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken). 2012;64(5):625–39.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  38. Smolen JS, Landewe R, Breedveld FC, Buch M, Burmester G, Dougados M, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis. 2014;73(3):492–509.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. Bartelds GM, Wijbrandts CA, Nurmohamed MT, Stapel S, Lems WF, Aarden L, et al. Clinical response to adalimumab: relationship to anti-adalimumab antibodies and serum adalimumab concentrations in rheumatoid arthritis. Ann Rheum Dis. 2007;66(7):921–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  40. Bendtzen K, Geborek P, Svenson M, Larsson L, Kapetanovic MC, Saxne T. Individualized monitoring of drug bioavailability and immunogenicity in rheumatoid arthritis patients treated with the tumor necrosis factor alpha inhibitor infliximab. Arthritis Rheum. 2006;54(12):3782–9.

    Article  CAS  PubMed  Google Scholar 

  41. Pascual-Salcedo D, Plasencia C, Ramiro S, Nuno L, Bonilla G, Nagore D, et al. Influence of immunogenicity on the efficacy of long-term treatment with infliximab in rheumatoid arthritis. Rheumatology (Oxford). 2011;50(8):1445–52.

    Article  CAS  PubMed  Google Scholar 

  42. Garces S, Demengeot J, Benito-Garcia E. The immunogenicity of anti-TNF therapy in immune-mediated inflammatory diseases: a systematic review of the literature with a meta-analysis. Ann Rheum Dis. 2013;72(12):1947–55.

    Article  CAS  PubMed  Google Scholar 

  43. Chiu HY, Wang TS, Chan CC, Lin SJ, Tsai TF. Risk factor analysis for the immunogenicity of adalimumab associated with decreased clinical response in Chinese patients with psoriasis. Acta Derm Venereol. 2015. doi:10.2340/00015555-2069 (Epub 12 Feb 2015).

  44. Hoffmann JH, Hartmann M, Enk AH, Hadaschik EN. Autoantibodies in psoriasis as predictors for loss of response and anti-infliximab antibody induction. Br J Dermatol. 2011;165(6):1355–8.

    Article  CAS  PubMed  Google Scholar 

  45. Menting SP, van Lumig PP, de Vries AC, van den Reek JM, van der Kleij D, de Jong EM, et al. Extent and consequences of antibody formation against adalimumab in patients with psoriasis: one-year follow-up. JAMA Dermatol. 2014;150(2):130–6.

    Article  CAS  PubMed  Google Scholar 

  46. Zisapel M, Zisman D, Madar-Balakirski N, Arad U, Padova H, Matz H, et al. Prevalence of TNF-alpha blocker immunogenicity in psoriatic arthritis. J Rheumatol. 2015;42(1):73–8.

    Article  CAS  PubMed  Google Scholar 

  47. Vogelzang EH, Pouw MF, Nurmohamed M, Kneepkens EL, Rispens T, Wolbink GJ, et al. Adalimumab trough concentrations in patients with rheumatoid arthritis and psoriatic arthritis treated with concomitant disease-modifying antirheumatic drugs. Ann Rheum Dis. 2015;74(2):474–5.

    Article  CAS  PubMed  Google Scholar 

  48. Fagerli KM, Lie E, van der Heijde D, Heiberg MS, Lexberg AS, Rodevand E, et al. The role of methotrexate co-medication in TNF-inhibitor treatment in patients with psoriatic arthritis: results from 440 patients included in the NOR-DMARD study. Ann Rheum Dis. 2014;73(1):132–7.

    Article  CAS  PubMed  Google Scholar 

  49. Gerards AH, de Lathouder S, de Groot ER, Dijkmans BA, Aarden LA. Inhibition of cytokine production by methotrexate. Studies in healthy volunteers and patients with rheumatoid arthritis. Rheumatology (Oxford). 2003;42(10):1189–96.

  50. Tian H, Cronstein BN. Understanding the mechanisms of action of methotrexate: implications for the treatment of rheumatoid arthritis. Bull NYU Hosp Jt Dis. 2007;65(3):168–73.

    PubMed  Google Scholar 

  51. Bendtzen K. Is there a need for immunopharmacologic guidance of anti-tumor necrosis factor therapies? Arthritis Rheum. 2011;63(4):867–70.

    Article  PubMed  Google Scholar 

  52. Gottlieb AB, Langley RG, Strober BE, Papp KA, Klekotka P, Creamer K, et al. A randomized, double-blind, placebo-controlled study to evaluate the addition of methotrexate to etanercept in patients with moderate to severe plaque psoriasis. Br J Dermatol. 2012;167(3):649–57.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  53. Zachariae C, Mork NJ, Reunala T, Lorentzen H, Falk E, Karvonen SL, et al. The combination of etanercept and methotrexate increases the effectiveness of treatment in active psoriasis despite inadequate effect of methotrexate therapy. Acta Derm Venereol. 2008;88(5):495–501.

    Article  CAS  PubMed  Google Scholar 

  54. Garman RD, Munroe K, Richards SM. Methotrexate reduces antibody responses to recombinant human alpha-galactosidase A therapy in a mouse model of Fabry disease. Clin Exp Immunol. 2004;137(3):496–502.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  55. Joseph A, Munroe K, Housman M, Garman R, Richards S. Immune tolerance induction to enzyme-replacement therapy by co-administration of short-term, low-dose methotrexate in a murine Pompe disease model. Clin Exp Immunol. 2008;152(1):138–46.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  56. Grange RD, Thompson JP, Lambert DG. Radioimmunoassay, enzyme and non-enzyme-based immunoassays. Br J Anaesth. 2014;112(2):213–6.

    Article  CAS  PubMed  Google Scholar 

  57. Steenholdt C, Bendtzen K, Brynskov J, Thomsen OO, Ainsworth MA. Clinical implications of measuring drug and anti-drug antibodies by different assays when optimizing infliximab treatment failure in Crohn’s disease: post hoc analysis of a randomized controlled trial. Am J Gastroenterol. 2014;109(7):1055–64.

    Article  CAS  PubMed  Google Scholar 

  58. Thorpe R, Swanson SJ. Current methods for detecting antibodies against erythropoietin and other recombinant proteins. Clin Diagn Lab Immunol. 2005;12(1):28–39.

    CAS  PubMed Central  PubMed  Google Scholar 

  59. Wang SL, Ohrmund L, Hauenstein S, Salbato J, Reddy R, Monk P, et al. Development and validation of a homogeneous mobility shift assay for the measurement of infliximab and antibodies-to-infliximab levels in patient serum. J Immunol Methods. 2012;382(1–2):177–88.

    Article  CAS  PubMed  Google Scholar 

  60. Prometheus. Insurance and financial support 2013. Available at: http://www.anserifx.com/PDF/Insurance-Financial-Support.pdf. Accessed 25 Nov 2014.

  61. Lallemand C, Kavrochorianou N, Steenholdt C, Bendtzen K, Ainsworth MA, Meritet JF, et al. Reporter gene assay for the quantification of the activity and neutralizing antibody response to TNF alpha antagonists. J Immunol Methods. 2011;373(1–2):229–39.

    Article  CAS  PubMed  Google Scholar 

  62. Thway TM, Magana I, Bautista A, Jawa V, Gu W, Ma M. Impact of anti-drug antibodies in preclinical pharmacokinetic assessment. AAPS J. 2013;15(3):856–63.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  63. van Schouwenburg PA, Bartelds GM, Hart MH, Aarden L, Wolbink GJ, Wouters D. A novel method for the detection of antibodies to adalimumab in the presence of drug reveals “hidden” immunogenicity in rheumatoid arthritis patients. J Immunol Methods. 2010;362(1–2):82–8.

    Article  PubMed  Google Scholar 

  64. Leonardi C, Strober B, Gottlieb AB, Elewski BE, Ortonne JP, van de Kerkhof P, et al. Long-term safety and efficacy of etanercept in patients with psoriasis: an open-label study. J Drugs Dermatol. 2010;9(8):928–37.

    PubMed  Google Scholar 

  65. Tyring S, Gordon KB, Poulin Y, Langley RG, Gottlieb AB, Dunn M, et al. Long-term safety and efficacy of 50 mg of etanercept twice weekly in patients with psoriasis. Arch Dermatol. 2007;143(6):719–26.

    Article  CAS  PubMed  Google Scholar 

  66. Armstrong AW, Bagel J, Van Voorhees AS, Robertson AD, Yamauchi PS. Combining biologic therapies with other systemic treatments in psoriasis: evidence-based, best-practice recommendations from the Medical Board of the National Psoriasis Foundation. JAMA Dermatol. 2015;151(4):432–8.

    Article  PubMed  Google Scholar 

  67. Braun J, Baraliakos X, Kudrin A, Kim H, Lee SJ. Striking discrepancy in the development of anti-drug antibodies (ADA) in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) in response to infliximab (INF) and its biosimilar CT-P13. Arthritis Rheum. 2014;66(12):L21.

  68. Adisen E, Aral A, Aybay C, Gurer MA. Anti-infliximab antibody status and its relation to clinical response in psoriatic patients: a pilot study. J Dermatol. 2010;37(8):708–13.

    Article  CAS  PubMed  Google Scholar 

  69. Wilsmann-Theis D, Fronhoffs K, Ehler LK, Wenzel J, Bieber T, Klingmueller K. Low-dose methotrexate: a therapeutical kick in TNF-alpha antagonist treatment for recalcitrant psoriasis vulgaris. Dermatol Ther. 2014;27(1):55–9.

    Article  PubMed  Google Scholar 

  70. Weise M, Bielsky MC, De Smet K, Ehmann F, Ekman N, Giezen TJ, et al. Biosimilars: what clinicians should know. Blood. 2012;120(26):5111–7.

    Article  CAS  PubMed  Google Scholar 

  71. US FDA. Guidance for industry: clinical pharmacology data to support a demonstration of biosimilarity to a reference product. Rockville: US Department of Health and Human Services, FDA; 2014.

    Google Scholar 

  72. Cipriani P, Ruscitti P, Carubbi F, Liakouli V, Giacomelli R. Methotrexate in rheumatoid arthritis: optimizing therapy among different formulations. Current and emerging paradigms. Clin Ther. 2014;36(3):427–35.

    Article  CAS  PubMed  Google Scholar 

  73. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon K, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: guidelines of care for the management and treatment of psoriasis with traditional systemic agents. J Am Acad Dermatol. 2009;61:451–85.

    Article  CAS  PubMed  Google Scholar 

  74. Pichlmeier U, Heuer KU. Subcutaneous administration of methotrexate with a prefilled autoinjector pen results in a higher relative bioavailability compared with oral administration of methotrexate. Clin Exp Rheumatol. 2014;32(4):563–71.

    PubMed  Google Scholar 

  75. Schiff MH, Jaffe JS, Freundlich B. Head-to-head, randomised, crossover study of oral versus subcutaneous methotrexate in patients with rheumatoid arthritis: drug-exposure limitations of oral methotrexate at doses ≥15 mg may be overcome with subcutaneous administration. Ann Rheum Dis. 2014;73(8):1549–51.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

Medical writing assistance was provided by Anna Abt, PhD, of ETHOS Health Communications, Newtown, PA, USA, with financial support from LEO Pharma Inc.

Conflicts of interest

The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P. Dr. Feldman is a speaker for Janssen and Taro, and is a consultant and speaker for Galderma, Stiefel/GlaxoSmithKline, Abbott Laboratories, and LEO Pharma Inc. He has received grants from Galderma, Janssen, Abbott Laboratories, Amgen, Stiefel/GlaxoSmithKline, Celgene, and Anacor, and is also a consultant for Amgen, Baxter, Caremark, Gerson Lehrman Group, Guidepoint Global, Hanall Pharmaceutical Co Ltd, Kikaku, Lilly, Merck & Co Inc, Merz Pharmaceuticals, Mylan, Novartis Pharmaceuticals, Pfizer Inc., Qurient, Suncare Research, and Xenoport. Dr. Feldman is also on an advisory board for Pfizer Inc. He is the founder of, and holds stock in, Causa Research, and also holds stock, and is the majority owner, in Medical Quality Enhancement Corporation. He receives royalties from UpToDate and Xlibris. M. Farhangian has no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA

    Michael E. Farhangian & Steven R. Feldman

  2. Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Steven R. Feldman

  3. Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Steven R. Feldman

Authors
  1. Michael E. Farhangian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven R. Feldman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael E. Farhangian.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Farhangian, M.E., Feldman, S.R. Immunogenicity of Biologic Treatments for Psoriasis: Therapeutic Consequences and the Potential Value of Concomitant Methotrexate. Am J Clin Dermatol 16, 285–294 (2015). https://doi.org/10.1007/s40257-015-0131-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40257-015-0131-y

Keywords

  • Rheumatoid Arthritis
  • Methotrexate
  • Psoriasis
  • Infliximab
  • Etanercept