The Exchange

Commentary and Observations from
the Medical Front Lines

Biologics in Psoriasis

Biologics in Psoriasis

The current understanding of the pathogenesis of psoriasis has led to the development of many immune-mediating biologic medications that specifically target overactive inflammatory cytokines. Biologics are different from traditional systemic drugs that impact the entire immune system in that they block the actions of specific types of immune cells and proteins that play a major role psoriatic disease.

There are several biologics approved by the US Food and Drug Administration that are currently used in the treatment of psoriasis. Tumor necrosis factor-alpha inhibitors include etanercept, adalimumab, infliximab, and certolizumab pegol. A single interleukin-12/23 inhibitor, ustekinumab, is available; secukinumab, ixekizumab, and brodalumab selectively target interleukin-17, while tildrakizumab, risankizumab, and guselkumab inhibit interleukin-23.

Biologics are given by injection or infusion, depending on the label. Before prescribing to a patient, the risks and benefits of treatment must be considered. Increase in the risk of infections, reactivation of certain infectious diseases, or worsening of certain medical conditions are potential side effects, so obtaining a thorough medical history is essential in choosing which agent to use. Although side effects may be a concern, all agents have long-term safety data on file, and most of the time the efficacy and improvement in a patient’s quality of life will outweigh the risks.

Recently, new guidelines have been published on the use of systemic therapy such as biologics for the treatment of psoriasis. Before prescribing these agents, please familiarize yourself with the current guidelines which include all the benefits, risks, indications, and contraindications.


Filed under: Dermatology

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