Biologics are one of the treatment options available for psoriasis. However, psoriasis sufferers will now have to cope with one less option.

Raptiva (efalixumab), a well-know biologic, will no longer be available, according to a press release published by manufacturer Genentech last week.

Genentech is voluntarily pulling the drug from the market in the United States because of, "an increased risk of progressive multifocal leukoencephalopathy (PML), a rare and usually fatal disease of the central nervous system." This will occur in phases, so that doctors have time to safely transition patients to an alternative.

If you're on Raptiva, don't stop taking the medication on your own. Doing so may cause a flare-up, so be sure to contact your healthcare provider to determine your next best steps. Your doctor may recommend that you transition to another biologic psoriasis drug, such as Amevive, Enbrel, Humira or Remicade.

an article in the British Journal of Dermatology (Br J Dermatol. 2008;159(6):1331-1337) looked at the rate of new-onset diabetes developing in patients with psoriasis. They took their data from the UK -based General Practice Research Database. The Risk of developing diabetes was higher in those patients with psoriasis. The severity of the psoriasis was what related to the risk of diabetes, not the BMI (body mass index) which would have related it to obesity instead (another common finding in diabetes). Psoriasis is being looked at more and more as a marker or risk factor for many other serious conditions.

The current issue of the American Journal of Cardiology contains a consensus document by dermatologists and cardiologists regarding the increased risk of cardiovascular disease in patients with psoriasis. The relationship between heart disease and psoriasis has been noted since 1961. Large epidemiological studies done since then have added support to the idea that psoriasis patients are indeed at risk for heart disease.

The consensus statement recommends that two groups of psoriasis patients be evaluated for vascular disease: those with moderate to severe psoriasis; and those with mild psoriasis plus a recognized risk factor for vascular disease such as abdominal obesity or hypertension.

A really interesting study from Turkey looked at serum homocysteine levels in patients with psoriasis. Elevated homocysteine levels are a recognized risk factor for heart disease. More recently, psoriasis itself has been proposed as an independent risk factor for heart disease. Two interesting finding from the study should be mentioned. Firstly, overally homocysteine levels did not differ significantly between psoriasis patients and controls. Second, and of possible clinical importance to patients is that homocysteine levels did correlate with the severity of psoriasis. Once conclusion that could possibly be raised by such data is that reducing the severity of psoriasis may in fact reduce the severity of heart disease. Although this has not been studied in and of itself, it may change the risk/benefit profiles of many treatments. The side effects of some psoriasis treatments may be more acceptable if in fact heart disease risk is also being mitigated.