• Brodalumab is an interleukin -17 receptor A antagonist which was approved by the US FDA on February 2017 for the treatment of moderate-to-severe plaque psoriasis.
Brodalumab is a human monoclonal antibody prescribed to treat moderate-or -severe plaque psoriasis
in patients who do not respond to other systemic treatments.
Plaque psoriasis is a skin disease in which the skin has red or scaly patches covered with a silver-white build up of dead skin cells. The lesions usually appears on the knee, elbow, scalp or lower back.
Brodalumab works by blocking inflammation by targeting the interleukin (IL)-17 receptor.
Brodalumab is not recommended in patients with:
• Allergy to the drug
• Crohn's disease (Brodalumab worsens the disease)
• Chronic or recurrent infections
• Active tuberculosis
• History of mental illness (anxiety or depression) or a mood disorder
• Age less than 18 years old
• The recommended adult dose is 210 mg injected subcutaneously once a week for 3 consecutive weeks.
• This is followed by injections of 210 mg once for every 2 weeks for a maximum of 16 weeks.
• Brodalumab comes as a solution or a liquid in a prefilled syringe which has to be injected as a subcutaneous injection (under the skin).
• The prefilled syringe should be used only once by injecting all the solution in the syringe. It should be disposed safely in a puncture-resistant container after use.
• Brodalumab can be injected into the thighs, upper arms or stomach except the navel and the area 2 inches around the navel.
• The syringe should not be shaken and care should be taken not to administer it on a psoriatic patch.
• Patients and caregivers should be advised about the suicidal ideation and behavior which is associated with brodalumab therapy.
• Anti-tubercular therapy should be initiated prior to brodalumab treatment in patients with latent or active tuberculosis.
• Continuous and close monitoring of patients should be carried out in both during and after brodalumab treatment.
• Monitoring of complete blood cell count during brodalumab therapy is needed as brodalumab reduces the number of white blood cells which leads to infection.
• Patient wallet cards that describe serious adverse effects must be carried by the patient at all times.
• Brodalumab should be avoided in pregnancy and breastfeeding women as there are no adequate data available regarding the safety and efficacy of the drug in these populations.
• Common: Influenza, tinea infections, headache, neutropenia, muscle pain.
• Gastrointestinal: Nausea, stomach cramps, diarrhea or constipation, loss of appetite, bloody or watery stools.
• Central nervous system: New or worsening anxiety or depression, unusual changes in mood or behavior, suicidal ideation
• ENT: Pain in the ear, ear drainage, trouble in hearing and breathing, cough, sore throat, symptoms of cold and flu
• Skin: Injection site reactions such as redness, pain, itching, bruising or bleeding
• Others: Conjunctivitis, candida infections, fatigue, joint pain, urinary tract infections
• The prefilled syringe, after removing from cold storage, should be allowed to come to a room temperature by keeping it out for at least 30 minutes. They should, however, not be refrigerated again.
• Do not use any other techniques to warm the prefilled syringe such as dropping in hot water or heating in a microwave oven.
• The injection should be inspected for any visible particles prior to administration and should be discarded if it is cloudy.
• Patients should be advised to read the FDA approved labeling which includes the medication guide and the instructions for use before using brodalumab.
• The use of live vaccines in patients taking brodalumab should be avoided.
• Since the effect of drugs metabolized by the enzyme CYP450 like warfarin and cyclosporine may be altered by brodalumab, monitoring of the treatment may be required.
• Brodalumab injection should be stored at a temperature of 2°C to 8°C in its original carton but should not be frozen.
• Prefilled syringes can be stored at a room temperature of up to 25°C in the original carton for a maximum period of 2 weeks and should be discarded if not used after this time limit.
• They should be protected from light and physical damage.