Abstract
Psoriasis is a chronic autoimmune disease and the choice of treatment depends on its severity. Nevertheless, it is not always easy to define the severity, as it depends not only from the extension of the skin involvement but also from the impact on the quality of life of these patients. According to the severity of the disease, both topical (mild to moderate psoriasis) and systemic (moderate to severe) treatments can be used. The main target of almost all systemic treatments for psoriasis is the immune system. An important therapeutic progress has been achieved since the introduction of biologics in the treatment of psoriasis.
Biologics are a heterogeneous group of monoclonal antibodies, fusion proteins, and recombinant cytokines that modify and regulate pivotal and specific mechanisms involved in psoriasis’ immunopathogenesis. Four biologics are available at the moment for the treatment of psoriasis: three antitumor necrosis factor alpha (TNFα) agents, namely, adalimumab, etanercept, infliximab, and one anti-IL12/23 monoclonal antibody (mAb), ustekinumab. In clinical studies as well as in daily practice, biologics have shown high efficacy both in the short- and in the long-term treatment together with a good safety profile. Nevertheless, it is of great importance in order to guaranty a good safety profile that the patients undergo a detailed screening prior to the beginning of the treatment and a regular follow-up.
Moreover, the better understanding of the pathogenetic mechanisms of psoriasis leads to continuous development of new therapeutic agents with very promising results.
Keywords
- Psoriasis
- Biologics
- Anti-TNFα
- AntiIL12-23
- Adalimumab
- Etanercept
- Infliximab
- Ustekinumab
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Gisondi P, Girolomoni G. Biologic therapies in psoriasis: a new therapeutic approach. Autoimmun Rev. 2007;6:515–9.
Gladman D, Mease P, Ritchlin C, et al. Adalimumab for long-term treatment of psoriatic arthritis. Forty-eight week data from the adalimumab effectiveness in psoriatic arthritis trials. Arthritis Rheum. 2007;56(2):476–88.
Gordon KB, Langley RG, Leonardi C, et al. Clinical response to adalimumab treatment in patients with moderate to severe psoriasis: double-blind, randomized controlled trial and open-label extension study. J Am Acad Dermatol. 2006;55:598–606.
Gottlieb AB, Evans R, Li S, et al. Infliximab induction therapy for patients with severe plaque-type psoriasis: a randomized, double-blind, placebo-controlled trial. J Am Acad Dermatol. 2004;51:534–42.
Griffiths CEM, Barker JNWN. Pathogenesis and clinical features of psoriasis. Lancet. 2007;370:263–71.
Gudjonsson J, Johnston A, Ellis CN, Arbor A. Novel systemic drugs under investigation for the treatment of psoriasis. J Am Acad Dermatol. 2012;67:139–47.
Krueger GG, Langley RG, Leonardi C, et al. A human interleukin-12/23 monoclonal antibody for the treatment of psoriasis. N Engl J Med. 2007;356:580–92.
Leonardi CL, Powers JL, Matheson RT, et al. Etanercept as monotherapy in patients with psoriasis. N Engl J Med. 2003;349:2014–22.
Leonardi CL, Kimball AB, Papp KA, Yeilding N, Guzzo C, Wang Y, Li S, Dooley LT, Gordon KB. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, doubleblind, placebo-controlled trial (PHOENIX 1). Lancet. 2008;371:1665–74.
Menter A, Feldman SR, Weinstein GD, et al. A randomized comparison of continuous vs. intermittent infliximab maintenance regimens over 1 year in the treatment of moderate-to-severe plaque psoriasis. J Am Acad Dermatol. 2007;56(1):31e1–15.
Menter A, Tyring S, Gordon K, et al. Adalimumab therapy for moderate to severe psoriasis: a randomized, controlled phase III trial. J Am Acad Dermatol. 2008;58(1):106–15; Epub 2007 Oct 23.
Mrowietz U, Kragballe K, Reich K, Spuls P, Griffiths CE, Nast A, et al. Definition of treatment goals for moderate to severe psoriasis: a European consensus. Dermatol Res. 2011;303(1):1–10; Epub 2010 Sep 21.
Nast A, Boencke WH, Mrowietz U, Ockenfels HM, Philipp S, Reich K, et al. S-3 guidelines on the treatment of psoriasis vulgaris (English version). Update. J Dtsch Dermatol Ges. 2012;10(Supp.2):S1–95.
Papp KA, Tyring S, Lahfa M, et al. A global phase III randomized controlled trial of etanercept in psoriasis: safety, efficacy, and effect of dose reduction. Br J Dermatol. 2005;152:1304–12.
Papp KA, Langley RG, Lebwohl M, Krueger GG, Szapary P, Yeilding N, Guzzo C, Hsu MC, Wang Y, Li S, Dooley LT, Reich K. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 52-week results from a randomised, doubleblind, placebo-controlled trial (PHOENIX 2). Lancet. 2008;371:1675–84.
Pathirana D, Ormerod AD, Saiag P, Smith C, Spuls PI, Nast A, et al. European S3-guidelines on the systemic treatments of psoriasis vulgaris. J Eur Acad Dermatol Venereol. 2009;23 Suppl 2:5–70.
Puig L, Carrascosa JM, Carretero G, de la Cueva P, Lafuente-Urrez RF, Belinchon I, et al. Spanish evidence based guidelines on the treatment of psoriasis with biologic agents, 2013. Part I: on efficacy and choice of treatment. Actas Dermosifiliogr. 2013;104(8):694–709.
Reich K, Nestle FO, Papp K, et al. Infliximab induction and maintenance therapy for moderate-to-severe psoriasis: a phase III, multicentre, double-blind trial. Lancet. 2005;366:1367–74.
Ryan C, Abramson A, Patel M, Menter A. Current investigational drugs in psoriasis. Expert Opin Investig Drugs. 2012;21(4):473–87.
Saurat JH, Stingl G, Dubertret L, Papp K, Langley RG, Ortonne JP, et al. Efficacy and safety results from the comparative study of adalimumab (Humira) versus methotrexate versus placebo in psoriasis patients (CHAMPION). Br J Dermatol. 2008;158(3):558–66; Epub 2007 Nov 28, 31-15.
Smith CH, Anstey AV, Barker JN, Burden AD, Chalmers RJ, Chandler DA, Finlay AY, Griffiths CE, Jackson K, McHugh NJ, McKenna KE, Reynolds NJ, Ormerod AD. British association of dermatologists’ guidelines for biologic interventions for psoriasis 2009. Br J Dermatol. 2009;161:987–1019.
Sterry W, Barker J, Boehncke WH, Bos JD, Chimenti S, Christophers E, De La Brassinne M, Ferrandiz C, Griffiths C, Katsambas A, Kragballe K, Lynde C, Menter A, Ortonne JP, Papp K, Prinz J, Rzany B, Ronnevig J, Saurat JH, Stahle M, Stengel FM, Van De Kerkhof P, Voorhees J. Biological therapies in the systemic management of psoriasis: International Consensus Conference. Br J Dermatol. 2004;151 Suppl 69:3–17.
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Papoutsaki, M., Antoniou, C. (2015). Biologic Agents for Psoriasis. In: Katsambas, A.D., Lotti, T.M., Dessinioti, C., D’Erme, A.M. (eds) European Handbook of Dermatological Treatments. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45139-7_137
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DOI: https://doi.org/10.1007/978-3-662-45139-7_137
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