Q: I have psoriasis since the last 15 years. I have tried all ointments, steroids, Neoral, Methotrexate but only got temporary relief. Presently I am not taking any drug and still have mild psoriasis for which I usually apply moisturisers. When and at what cost will the new biologic therapies like Enbrel, Ramicade, Amevive etc approved by USFDA become available in India ? I have heard that they are breakthrough drugs for psoriasis.

A:Psoriasis is a chronic but a relatively harmless disease and there are various modalities available. As far as the drugs you have mentioned: Enbrel (Etanercept) is made by Wyeth and is relatively useful for moderate to severe psoriasis. It is yet to come to the Indian stores but is available in the grey market. But as this is an anti-tumor necrosis factor (TNF), it is hardly suitable for you as your psoriasis is mild. Besides this medicine is costly and has a few side effects like serious infections in diabetics, bleeding disorders etc. Remicade (Infliximab) is also a promising drug for moderate to severe psoriasis (defined as involving five percent or more of the body surface). It is a monoclonal antibody that specifically targets and irreversibly binds to a key inflammatory mediator called tumor necrosis factor alpha (TNF-alpha), which is believed to play a pivotal role in psoriasis. It is a relatively safe drug but slightly costly even by US standards. Again, in your case of mild psoriasis it is not applicable. Amevive (Alefacept) is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy. It is an injectable form of therapy. Adverse reactions are lymphopenia, malignancies, serious infections requiring hospitalization, hypersensitivity reactions etc. These medications are not yet available in India and they have their critics abroad too. Contrary to your belief that they are break through therapies, I must disappoint you that these are just new additions to the already vast array of medicines tried for psoriasis but by no strech of imagination are these WONDER DRUGS. None claims to be superior to the previously tried drugs and none can claim to CURE psoriasis. So my advice to you would be carry on with the treatments available in India and only graduate to these drugs if all other treatments have failed to provide you relief. In my opinion these are costly medicines (especially in the grey market) and not really required in your case. WHEN they shall be available I cant say as till now even Tretinoin hasnt been cleared by our government so your guess is as good as mine.