Choosing First-Line Biologic Treatment for Moderate-to-Severe Psoriasis: What Does the Evidence Say?

Abstract

An advanced understanding of the pathogenesis of psoriasis has led to the development of multiple therapeutic options for moderate-to-severe psoriasis. Tumor necrosis factor inhibitors, ustekinumab, interleukin-17 inhibitors, and guselkumab (an interleukin-23 inhibitor recently approved for psoriasis) are commercially available biologic agents for psoriasis. Evidence from clinical trials provides pertinent information regarding the safety and efficacy of biologic agents for psoriasis, which should be integrated into clinical decision making. However, disease presentations, disease severity, and comorbid conditions can complicate the choice of initial treatment, which underscores the importance of providing personalized therapy for patients with psoriasis. Furthermore, each biologic agent offers unique benefits and limitations for the treatment of patients with psoriasis. Here, evidence-based recommendations are presented and discussed regarding first-line biologic therapy options for patients with psoriasis and distinct comorbid conditions or patient-related factors. We discuss the comorbid conditions of psoriatic arthritis, multiple sclerosis, congestive heart failure, inflammatory bowel disease, hepatitis B, and latent tuberculosis. Moreover, we describe treatment recommendations for distinct patient populations with psoriasis, including pediatric patients with psoriasis and patients with psoriasis of childbearing potential and nursing.

Biologics for psoriasis: What is new?

“…Comparable results reported about the efficacy etanercept, adalimumab, and infliximab for PsA. Distinctly, infliximab is more effective at clearing skin lesions, followed by adalimumab and then etanercept (Amin et al, ; Table ). Certolizumab pegol and golimumab are FDA approved drugs for PsA.…”

“…Chronic joint inflammation of PsA may lead to structural damage, finally leading to significant functional impairment and disability. Early diagnosis and appropriate treatment are significant for preventing irreversible damage to joints (Amin et al, ). Comparable results reported about the efficacy etanercept, adalimumab, and infliximab for PsA.…”

“…FDA approved secukinumab for adults with active PsA (Table ). Brodalumab and ixekizumab, other interleukin‐17 inhibitors, significantly improved response rates for patients with PsA in a phase II and phase III studies, respectively (Amin et al, ). Bimekizumab, is currently in phase III clinical trials, a new biologic that inhibits both IL‐17A and IL‐17F (Table ).…”

“…Alefacept and efalizumab were first biologics approved by U.S. Food and Drug Administration (FDA) in 2003. However, they were withdrawn from the market in 2011 and 2009, concerning the safety in postmarketing surveillance (Amin, Daniel, Egeberg, & Wu, 2018).…”

Draft interdisciplinary guidelines for diagnosis, methods for estimation of the degree of activity, for evaluation of therapeutic efficacy, and for use of biological agents in patients with concomitant immunoinflammatory diseases (psoriasis, psoriatic arthritis, Crohn's disease)

“…Низкая иммуногенность и благоприятный профиль безопасности отличают УСТ от ГИБП других классов. По данным международных регистров, УСТ характеризуется самым высоким показателем «выживаемости» терапии среди всех ГИБП [37][38][39][40][41].…”