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Treating Psoriasis If Enbrel Fails

Study Shows Stelara and Remicade Are Both Effective if Enbrel Stops Working

Comparing Psoriasis Treatments continued...

By 10 weeks later, two-thirds had, at most, minimal disease.

So if you fail Enbrel, how do you decide whether to try Remicade or Stelara?

There has been no head-to head comparison, but generally Stelara is reserved for people with more severe disease, Menter notes.

"Once on it, the vast majority of patients maintain improvement over the course of the next few years," he adds.

If the patient's joints are inflamed, "I may be more likely to use a TNF-alpha blocker," which have been used to treat arthritis for over a decade, Menter says. (A study looking at the effects of Stelara on joint inflammation is just starting.)

In general, the safety of all three drugs has been similar in various studies, he says.

But Stelara has not been around long enough for researchers to know if it will increase the risk for infections or cancer, known risks of biologic agents that affect the body's immune system, says past American Academy of Dermatology president Darrell S. Rigel, MD, clinical professor of dermatology at New York University Medical Center.

The bottom line, he tells WebMD, is that many psoriasis patients have been helped by Enbrel for psoriasis.

"If it doesn't work well or stops working, [Stelara and Remicade] are very good drugs to consider. But if a drug is working, I would stay on it," he says.

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