Efficacy and Safety of Biologics for Psoriasis and Psoriatic Arthritis and Their Impact on Comorbidities: A Literature Review

Abstract

Psoriasis is a chronic inflammatory skin disease characterized by scaly indurated erythema. It impairs patients’ quality of life enormously. It has been recognized not only as a skin disease but as a systemic disease, since it also causes arthritis (psoriatic arthritis) and mental disorders. Furthermore, an association with cardiovascular events is indicated. With the advent of biologics, treatment of psoriasis dramatically changed due to its high efficacy and tolerable safety. A variety of biologic agents are available for the treatment of psoriasis nowadays. However, characteristics such as rapidity of onset, long-term efficacy, safety profile, and effects on comorbidities are different. Better understanding of those characteristic leads to the right choice for individual patients, resulting in higher persistence, longer drug survival, higher patient satisfaction, and minimizing the disease impact of psoriasis. In this paper, we focus on the efficacy and safety profile of biologics in psoriasis patients, including plaque psoriasis and psoriatic arthritis. In addition, we discuss the impact of biologics on comorbidities caused by psoriasis.

Topical Application of Mesenchymal Stem Cell Exosomes Alleviates the Imiquimod Induced Psoriasis-Like Inflammation

“…This is detectable even in a mild psoriatic phenotype induced by 3 days IMQ treatment of mouse skin. IL-17 and IL-23 [ 28 , 34 , 35 ] are the major cytokines implicated in the pathogenesis of psoriasis and are also the major therapeutic targets in the treatment of psoriasis [ 8 ]. The importance of these cytokines in mediating the inflammatory phenotype is reflected in their involvement in other inflammatory skin disorders including atopic dermatitis [ 36 ], diabetic wound [ 37 , 38 ], contact dermatitis [ 39 , 40 , 41 ], acne [ 42 ], and keloids [ 43 ].…”

“…Most of the small molecules reduce cellular proliferation or suppress immune activity while the biologics target inflammatory cytokines in the IL-23/Th17 axis and TNF-α-signaling [ 4 ]. However, long-term use of these systemic treatments is often complicated by toxic side effects such as hepatotoxicity, nephrotoxicity, hypertension, tremors, hypomagnesemia, hyperkalemia, and malignancies [ 5 , 6 , 7 ], inadequate long term patient compliance [ 8 ] and anti-drug responses [ 9 , 10 ]. Therefore, there is still a need for alternative treatment modalities for at-risk or non-responsive patients.…”

Oxidative Stress as an Important Contributor to the Pathogenesis of Psoriasis

“…Among them, methotrexate, cyclosporine, and oral retinoids are implemented, but the high dose and/or long-term usage of these agents still raises safety concerns [ 112 ]. On the other hand, due to its tolerable safety and high efficacy, biologics are now extensively investigated [ 113 ]. However, some cohort studies have shown that they are not effective to all individuals with Ps and may have some impact on comorbidities [ 114 ].…”

Patient-Centered Care in Psoriatic Arthritis—A Perspective on Inflammation, Disease Activity, and Psychosocial Factors

“…Reviews on the efficacy and safety of biologics in psoriasis and PsA have been previously published [ 64 ]; therefore, we focus on novel agents that have garnered much attention. The Janus kinase/signal transducers and activators of transcription (JAK-STAT) pathway represents a recent target of therapeutic interest in PsA.…”

“…Conventional and biologic DMARDs are the staple of the rheumatologist’s treatment armamentarium with their efficacy and safety in inflammatory arthritis. New agents targeting different cytokine signaling pathways hold promise to improve on the current efforts to control disease manifestations with preliminary data indicating that benefits in patient-oriented outcomes are favorable [ 2 , 64 ]. Controlling disease activity and improving functional status and pain can be achieved with baricitinib and methotrexate when compared to a combination with adalimumab in RA.…”