Biologic Therapy for Moderate to Severe Psoriasis in Children and Adolescents
This protocol covers moderate to severe psoriasis in pediatric patients — children and adolescents — where systemic biologic therapy is indicated. It specifies agent options, their administration routes, and how selection is guided by age and weight.
Clinical Goal
The primary target is a 75% or greater improvement in the Psoriasis Area and Severity Index (PASI 75), assessed at approximately 12 to 16 weeks of treatment.
Treatment Approach
Management involves biologic therapy, with options that may be given subcutaneously or intravenously on structured schedules. The choice of agent — and the precise timing and weight-based dosing — depends on the patient's age and weight. The complete regimen, including which agents are available, selection criteria, and the full dosing schedule, is set out in the protocol below.
References
DOI: 10.1016/j.jaad.2019.08.049
- Etanercept is recommended as an effective therapy for moderate to severe psoriasis in children 6 years of age and older.
- Adalimumab is recommended for off-label use as an effective therapy in children and adolescents with moderate to severe psoriasis.
- Infliximab can be recommended as monotherapy or in combination with methotrexate for use in pediatric patients with severe plaque or pustular psoriasis that is unresponsive to other systemic medications, rapidly progressive, unstable, and/or life threatening.
- Ustekinumab is recommended as an effective therapy for adolescents 12 years and older with moderate to severe plaque psoriasis.
- Etanercept showed a significant effect relative to placebo, with achievement of PASI 75 or greater in 57% versus 11%, respectively.