The emergence of data from clinical trials of biologics, the approval of new biologics, and our improved understanding of psoriasis pathogenesis have increased the therapeutic possibilities for the treatment of moderate-to-severe psoriasis. Biologics currently approved for the treatment of psoriasis include tumor necrosis factor inhibitors, interleukin (IL)-17 inhibitors, ustekinumab (an IL-12/23 inhibitor), and IL-23 inhibitors. Data from clinical trials and studies of the safety and efficacy of biologics provide essential information for the personalization of patient care. We discuss the benefits and disadvantages of biologics as a first-line treatment choice, update treatment recommendations according to current evidence, and propose psoriasis treatment algorithms. Our discussion includes the following comorbid conditions: psoriatic arthritis, multiple sclerosis, congestive heart failure, inflammatory bowel disease, hepatitis B, nonmelanoma skin cancer, lymphoma, and latent tuberculosis. We make evidence-based treatment recommendations for special populations, including pediatric patients, patients with coronavirus 2019 (COVID-19), and pregnant and breastfeeding patients with psoriasis. Ultimately, individualized recommendations that consider patient preferences, disease severity, comorbid conditions, and additional risk factors should be offered to patients and updated as new trial data emerges.

were randomly placed in the control group in a 10:1 size ratio compared with the AD group. Individuals without known ethnicity or race, type of payment, and/or sex were then excluded. Laboratory-confirmed cases of COVID-19 between January 1, 2020, and April 17, 2021, were identified (Supplemental Fig I available via Mendeley at https://data.mendeley.com/datasets/j95wfcyy3j/1). A description of the methodology for this retrospective study is provided in Supplemental Methods (available via Mendeley at https://data.mendeley. com/datasets/t26gnt3pss/1), Supplemental Table I (available via Mendely at https://data.mendeley.com/ datasets/ww6b5n327m/1), and Supplemental Table II (available via Mendeley at https://data.mendeley. com/datasets/tbh86d3z8r/1).The AD and non-AD cohorts included 39,417 and 397,293 subjects, respectively (Table I). Poisson regression revealed a crude COVID-19 incidence rate ratio (IRR) of 1.41 (95% CI 1.34-1.48) for adults with AD compared with adults without AD (Table II). After adjusting for demographic factors and baseline comorbidities, the IRR remained statistically significant but was reduced to 1.18 (95% CI 1.12-1.24).

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