Biologic Treatments of Psoriasis: An Update for the Clinician

Abstract

The advent of biologic agents within the past two decades has dramatically improved the treatment of psoriasis and psoriatic arthritis. Given that there now exists 11 FDA approved biologic options available for psoriasis, with more in the pipeline, the therapeutic armamentarium has been greatly enhanced. However, the fact that there are so many available options has also caused confusion for providers. Therefore, this manuscript deliberately focuses on the most clinically useful facts (such as efficacy and safety data) about each and every FDA approved biologic agent (including pipeline agents) for psoriasis. Moreover, among the clinically relevant facts, this manuscript purposely emphasizes the unique merits and demerits of each agent to make it easier for the provider to select which one of these many options is the best for the particular patient on hand. The goal of this manuscript is to aid the busy practicing dermatologist in becoming more adept at using these agents with the ultimate aim of improving patient care.

Keywords: IL 12/23; IL-17; IL-23; TNF-alpha; biologic therapy; psoriasis; psoriatic arthritis.

Figure 1

Plasma certolizumab concentrations in mothers and infants b. Infant samples were collected within 24 hours post-delivery, while mother samples could be collected within 24 hours before or after delivery; c. ±7 days (two samples missing); d. ±7 days.

Figure 2

Annual treatment costs per PASI 75. PASI indicates Psoriasis Area and Severity Index.

Figure 3

Clear skin responses (PASI 100) was greater among secukinumab treated patients compared to ustekinumab at every time point from week 4 out to week 16 in the CLARITY study. *p < 0.0001. Notes: Reproduced from Bagel J, Nia J, Hashim PW, et al. Secukinumab is Superior to Ustekinumab in Clearing Skin in Patients with Moderate to Severe Plaque Psoriasis (16-Week CLARITY Results). Dermatol Ther (Heidelb). 2018;8(4):571-579. Copyright © 2018, Springer-Verlag GmbH Germany, part of Springer Naturek.

Figure 4

Head-to-head comparison showed faster onset of action for ixekizumab vs guselkumab in the treatment of plaque psoriasis. The red box indicates the primary endpoint for the study. Notes: Reproduced from Blauvelt et. al. Ixekizumab vs. Guselkuamb: 24 week clinical responses and 4-week gene expression data. Oral presentation presented at the: Maui Derm; June 2020; Virtual Congress.

Figure 5

Schematic structure of bimekizumab and its binding sites: IL-17A/IL-17F heterodimers, IL-17A/IL-17A homodimers, and IL-17F-IL-17F homodimers. Notes: Reprinted from  Blauvelt A, Chiricozzi A, Ehst BD. Bimekizumab,Current Dermatology Reports. Copyright 2020, with permission from Springer Nature.

Figure 6

Relapse rates in reSURFACE 1 study in patients re-randomized to placebo at week 28. Notes: Reproduced from Thaçi Iversen L, Pau-Charles I, Rozzo S, Blauvelt A, Reich K. Long-term efficacy and safety of tildrakizumab in patients with moderate-to-severe psoriasis who were responders at week 28: pooled analysis through 3 years (148 weeks) from reSURFACE 1 and reSURFACE 2 phase 3 trials. Oral presentation presented at the: 27th European Academy of Dermatology and Venereology (EADV) Congress; September 2018; Paris, France.