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Biological Products for the Treatment of Psoriasis: Therapeutic Targets, Pharmacodynamics and Disease-Drug-Drug Interaction Implications

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Abstract

Psoriasis is a chronic inflammatory skin disease condition that involves altered expression of a broad spectrum of proinflammatory cytokines which are associated with activation of T cells and proliferation of keratinocytes. Currently approved biological products for psoriasis treatment fall into two main classes: cytokine modulators and biologics targeting T cells. In psoriatic patients, elevated levels of proinflammatory cytokines are observed. Elevated proinflammatory cytokines can suppress some cytochrome P450 (CYP) enzymes, and the treatment of psoriasis with biological products can reduce proinflammatory cytokine levels. Therefore, the exposure of CYP substrate drugs is anticipated to be affected by the psoriasis disease resulting in a higher exposure than in healthy state (named disease-drug interaction) as well as by the biological treatments due to disease improvements resulting in a decrease in exposure (named disease-drug-drug interaction, disease-DDI). However, the quantitative impact on CYP substrate exposure due to disease or due to treatment with biological products remains to be evaluated. The objective of the current review is to provide an overview of the therapeutic targets and cytokine-related pharmacodynamic effects of biological products in psoriasis treatment with a particular focus on their implications for disease-DDI. The clinical study design considerations for psoriasis disease-DDI evaluation are also discussed.

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Abbreviations

CYP:

Cytochrome P450

Disease-DDI:

Disease-drug-drug interactions

IL:

Interleukin

TNFα:

Tumor necrosis factor α

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Acknowledgments

The authors wish to thank Dr. E. Dennis Bashaw for his critical review of this manuscript and valuable comments.

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  1. Division of Clinical Pharmacology III, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, Maryland, 20993, USA

    Jie Wang, Yow-Ming C. Wang & Hae-Young Ahn

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  1. Jie Wang
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Correspondence to Yow-Ming C. Wang.

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The opinions expressed in this article are those of the authors who are affiliated with the United States Food and Drug Administration (FDA) and do not necessarily reflect the official views or policies of the FDA. The authors did not receive external funding for this project.

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Wang, J., Wang, YM.C. & Ahn, HY. Biological Products for the Treatment of Psoriasis: Therapeutic Targets, Pharmacodynamics and Disease-Drug-Drug Interaction Implications. AAPS J 16, 938–947 (2014). https://doi.org/10.1208/s12248-014-9637-0

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