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Brodalumab is a monoclonal antibody approved by the United States Food and Drug Administration (FDA) to treat moderate to severe plaque psoriasis in adult patients who have failed treatment with topical and other systemic therapy. In addition to plaque psoriasis, brodalumab has been explored as a potential treatment for other auto-inflammatory diseases, including psoriatic and rheumatoid arthritis. This activity reviews the mechanism of action, adverse event profile, toxicity, dosing, pharmacodynamics, and monitoring of brodalumab, pertinent for interprofessional team members for the treatment of patients with indicated inflammatory pathologies. Objectives: Identify the indications for brodalumab. Summarize the mechanism of action of brodalumab. Review the potential adverse events for patients using brodalumab. Outline the importance of improving care coordination among the interprofessional team to improve outcomes for patients using brodalumab therapy for indicated conditions. Access free multiple choice questions on this topic.

The management of patients with psoriasis is usually by the primary care provider, nurse practitioner, dermatologist, infectious disease consultant, internist, and rheumatologist. When the disease is moderate to severe, one option for treatment is brodalumab. This new agent was approved by the United States Food and Drug Administration for the treatment of moderate to severe plaque psoriasis in adult patients who have failed treatment with topical and other systemic therapy. The drug is effective and does provide rapid symptom relief, but monitoring of patients is necessary. Due to the increased risk of infection in patients prescribed brodalumab, all patients require screening for tuberculosis (TB) prior to initiation of the medication. If a patient has an active TB infection, they should not receive the drug. For patients with latent TB or a history of latent or active TB with unconfirmed treatment, therapy for TB infection should start before the initiation of brodalumab, as there is a risk for latent TB reactivation. Patients should be informed of the increased risk of neutropenia and must have ongoing monitoring for any new or non-resolving infections. Additionally, live vaccines should be avoided in patients while they are taking brodalumab. Pharmacists should carefully verify dosing and perform complete medication reconciliation for patients commencing therapy on brodalumab and report any concerns to the healthcare team. Nursing staff can assist in all the above monitoring activities, help evaluate ongoing treatment effectiveness, and confirm patient compliance. Should they note any issues, these must be reported to the prescribing physician immediately.

Patients should be informed of the increased risk of neutropenia and must have ongoing monitoring for any new or non-resolving infections. Additionally, live vaccines should be avoided in patients while they are taking brodalumab. Pharmacists should carefully verify dosing and perform complete medication reconciliation for patients commencing therapy on brodalumab and report any concerns to the healthcare team. Nursing staff can assist in all the above monitoring activities, help evaluate ongoing treatment effectiveness, and confirm patient compliance. Should they note any issues, these must be reported to the prescribing physician immediately. Because of its adverse event profile and potential for increased infections, brodalumab treatment requires an interprofessional team approach, including clinicians (MDs, DOs, NPs, PAs), specialists, specialty-trained nurses, and pharmacists, all collaborating across disciplines to achieve optimal patient results. After the drug is prescribed by the clinician, nursing staff should review all pertinent dosing and administration points and verify patient understanding. The pharmacist should monitor for drug-drug interactions and answer any other patient questions while reinforcing the points taught by nursing. This interprofessional approach will result in better therapeutic success with fewer adverse outcomes. [Level 5]