– In patients with both psoriasis and PsA, the recommendations from both the European League Against Rheumatism (EULAR) and the British Association of Dermatologists (BAD) indicate that TNF inhibitors are the preferred first line biologic unless TNFs are contraindicated. 1,2
Full Answer
Should biologics be a first-line treatment choice for psoriasis?
Tumor necrosis factor inhibitors, ustekinumab, interleukin-17 inhibitors, and guselkumab (an interleukin-23 inhibitor recently approved for psoriasis) are commercially available biologic agents for psoriasis. Evidence from clinical trials provides pertinent information regarding the safety and efficacy of biologic agents for psoriasis, which should be integrated into clinical …
What are the treatment options for psoriasis?
What can clinical trials tell us about psoriasis treatment efficacy?
Are there head-to-head randomized clinical trials of plaque psoriasis treatments?
Feb 01, 2018 · American Journal of Clinical Dermatology. An advanced understanding of the pathogenesis of psoriasis has led to the development of multiple therapeutic options for moderate-to-severe psoriasis. Tumor necrosis factor inhibitors, ustekinumab, interleukin-17 inhibitors, and guselkumab (an interleukin-23 inhibitor recently approved for psoriasis) are …
What is the first-line treatment for psoriasis?
Light therapy. Light therapy is a first-line treatment for moderate to severe psoriasis, either alone or in combination with medications. It involves exposing the skin to controlled amounts of natural or artificial light.May 2, 2020
Which biologic is most effective for psoriasis?
Brodalumab, guselkumab, ixekizumab and risankizumab stood out among 15 biologic and oral medications as having the highest short- and long-term response rates for the treatment of moderate-to-severe plaque psoriasis, according to a recent meta-analysis.Apr 15, 2020
What is the best treatment for severe psoriasis?
Systemic TreatmentsMethotrexate. This is only for people with serious symptoms. ... Cyclosporine. This is used most for serious psoriasis. ... Enzyme inhibitor. A newer drug called apremilast can target and slow down inflammation in certain immune cells. ... Oral retinoids. Acitretin is a synthetic form of vitamin A.Jun 22, 2021
How do I choose a biologic?
The main factors that affect the choice of biologic treatment include safety (such as short-term tolerability and long-term risk issues), efficacy (including the efficacy of the drug on the disease and on the comorbidities of the disease), cost of therapy, the convenience of the treatment, our general impressions of ...
What is biologics treatment for psoriasis?
Biologics work by blocking reactions in your body that cause psoriasis and its symptoms. If you have psoriatic arthritis, a biologic can stop the pain, stiffness, and swelling in your joints. It can prevent the arthritis from worsening and causing more damage to your joints.
What is biologic therapy?
A type of treatment that uses substances made from living organisms to treat disease. These substances may occur naturally in the body or may be made in the laboratory. In cancer, some biological therapies stimulate or suppress the immune system to help the body fight cancer.
What is approved to treat moderate to severe plaque psoriasis in adults?
Ixekizumab (Taltz) was FDA-approved in March 2016 to treat adults with moderate to severe psoriasis. It's intended for people who are candidates for phototherapy, systemic therapy, or both.Mar 31, 2020
How do people live with severe psoriasis?
Regular exercise and a healthy diet are recommended for everyone, not just people with psoriasis, because they can help to prevent many health problems. Eating a healthy, balanced diet and exercising regularly can also relieve stress, which may improve your psoriasis.
What is considered severe psoriasis?
If more than 10% of your body is affected, or if large areas on your face, palms or soles of your feet have patches, you have severe psoriasis.Oct 28, 2021
Which biologic is best?
Humira. The anti-inflammatory drug Humira (adalimumab) is not only the best-selling biologic, it's one of the best-selling drugs worldwide, regardless of class.Oct 11, 2021
How do I choose a biologic for asthma?
Which biologic should I choose for my asthmatic patient? When choosing a biologic medication for their patients with severe uncontrolled asthma, clinicians should always take into account the asthma endotype, clinical biomarkers, and patient-focused aspects (Fig 1).Aug 13, 2021
What are the factors that contribute to psoriasis?
Etiology of psoriasis is unclear but environmental, genetic, and immune factors act significant roles in the pathogenesis of this disease. Helper Tcells (TH), plasmoid and dermal dendritic cells play a prominent role in the development of classical psoriatic lesions. Interleukin stimulation is another important process in the pathogenesis of the disease that directly influences keratinocytes and leading to the formation of psoriatic pattern in the skin. Tumor necrosis factor (TNF) α which releases from keratinocytes activates dendritic cells in the early stages of complex pathogenesis of psoriasis. Activated keratinocytes produce also, other proinflammatory cytokines (IL‐1b, and IL‐6), antimicrobial peptides, and various chemokines. TNF activates dendritic cells that produce IL‐23, leading to TH17 differentiation. TH17 cells secrete IL‐17A, which has been shown to promote psoriatic skin changes. Consequently, after clarification of these main pathological mechanisms, anti‐IL therapies have been accepted as a major treatment for patients with moderate‐tosevere psoriasis. Here, actual information will be presented about biological agents currently in clinical use or being tested for clinical application for treatment of patients with psoriasis. This article is protected by copyright. All rights reserved.
What is the prevalence of psoriasis in Croatia?
Psoriasis is a common chronic inflammatory skin disease which affects 0.5-1 % of children and 2-3 % of the adult population. In Croatia, 1.6 % of the population suffer from psoriasis. Distribution of the disease is bimodal, with the first peak at the age of 20-30, and the second at the age of 50-60. The etiopathogenesis of the disease is multifactorial, the key factors being genetic predisposition combined with immunological disorders, environmental factors and skin barrier damage. There are several clinical variants of the disease. The main signalling pathways in psoriasis include TNF-α, IL-23 and IL-17. Topical agents are used for the treatment of the mild form, and the systemic conventional therapy is used for the treatment of moderate to severe forms of the disease. In cases where's no response, or intolerance or contraindications are present, new targeted medications are to be administered. Development in the field of immunogenetics of psoriasis leads to personalized medicine.
What are the immunoinflammatory diseases?
Due to that one patient may be at high risk for developing several immunoinflammatory diseases (psoriasis, psoriatic arthritis (PsA), and Crohn's disease (CD)), their early diagnosis and adequate therapy are extremely relevant. The Interdisciplinary Working Group that includes experts in rheumatology, gastroenterology and dermatology has developed draft guidelines for early diagnosis, methods for activity assessments and for indications for the use of biological agents in patients with concomitant immunoinflammatory diseases (psoriasis, PsA, and CD). In accordance with the decision adopted by the Council of Experts and with the results of a discussion with experts from different regions of the Russian Federation, further steps will be undertaken to validate the guidelines.
Is Guselkumab a biologic?
Further understanding of psoriasis pathogenesis has led to the development of effective biologic medications. Guselkumab (GUS) is a subcutaneously administered monoclonal antibody that targets the p19 cytokine subunit in IL-23 and IL-39 and is US Food and Drug Administration (FDA) approved for the treatment of moderate-to-severe psoriasis in adult patients. This review evaluates the pharmacology, safety and efficacy of GUS in patients with psoriasis. We performed a literature review by searching online databases including PubMed and Google Scholar. In clinical trials, GUS improved diseases including psoriatic arthritis (PsA) and specific areas of disease (scalp, feet, hands and fingernails). In the Phase III trials VOYAGE 1 and 2, more GUS than adalimumab (ADM) patients experienced a ≥90% reduction in Psoriasis Area and Severity Index (PASI) score (PASI90) (VOYAGE 1: 80.2% vs 53.0%; VOYAGE 2: 75.2% vs 54.8%; P<0.001 for both) and Investigator Global Assessment score of 0 or 1 (VOYAGE 1: 84.2% vs 61.7%; VOAYGE 2: 83.5% vs 64.9%; P<0.001 for both) at Week 24. GUS was also successful in treating patients unresponsive to ADM and ustekinumab in the VOYAGE 2 and NAVIGATE trials, respectively. While long-term data are necessary, GUS appears to have a favorable side effect profile with most common adverse effects including nasopharyngitis and upper respiratory tract infections. GUS is a well-tolerated and effective medication for patients with psoriasis. Continued study of GUS and the p19 subunit will help to determine GUS’s ultimate place in therapy.
What is DMARDs treatment?
Introduction: The treatment of psoriasis with conventional topical therapies and disease-modifying anti-rheumatic drugs (DMARDs) is often linked to unsatisfactory outcomes and the risk of serious adverse events. Over the last decades, research advances in understanding the role of tumor necrosis factor alpha (TNF α) and other cytokines in the pathogenesis of psoriasis have driven the introduction of biologic agents targeting specific immune mediators in everyday clinical practice. TNF α inhibitors are a consolidated treatment option for patients with moderate-to-severe disease with remarkable efficacy and a reassuring safety profile. Areas covered: The PubMed database was searched using combinations of the following keywords: psoriasis, TNF α inhibitors, biologic therapy, pharmacodynamics, adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, adverse effects. The aim of this review is to describe the pharmacodynamic profile of anti-TNF α inhibitors, currently approved by the European Medicines Agency (EMA) for the treatment of psoriasis, focusing on related clinical implications, also in comparison to the new generation biological therapies targeting the interleukin 23/interleukin 17 axis. Expert opinion: Pharmacodynamics of TNF α inhibitors should be fully considered in planning patient’s therapy strategies, especially in case of secondary failures, poor adherence to treatment, instable psoriasis, high risk of infection, pregnant or lactating women, metabolic comorbidities, coexistence of other immune-mediated inflammatory diseases.
Is psoriasis a multisystem disease?
Psoriasis is a chronic multisystem inflammatory disease affecting primarily the skin and joints but also involves several comorbidities. The disease affects between 0.2 and 4% of the population worldwide. The Kasr Al-Ainy Psoriasis Unit developed a protocol of therapy for psoriasis. Part I discussed the topical and systemic therapies. This part discusses the biological therapy. Biological therapies for psoriasis are agents that can specifically target an immune mediator and block specific molecular steps important in the pathogenesis of psoriasis. Despite the cost, the use of biological therapies in psoriasis is sometimes necessary. However, the adequate choice of biologic in the proper indication is mandatory for cost-benefit balance for the patient. Physicians using biological therapies should be familiar with complications. The protocol offers regional physicians a practical algorithm for choice of biological therapies in psoriasis and a full workup before therapy and during follow-up. Authors highlight the safety and efficacy data of biologic therapies available in the Egyptian market, with special focus on particular situations (hepatitis, tuberculosis, and demyelinating disorders).
Is psoriasis a chronic disease?
Psoriasis and inflammatory bowel disease (IBD) are multifactorial chronic immuno-inflammatory potentially disabling disorders with similar genetic factors and immunological pathways, in particular, genetic polymorphisms of IL-23R, which determines the signal IL-12/23-mediated pathway of immunopathogenesis. The emergence of genetically engineered biological agents has changed the prognosis for both psoriasis and IBD. The intersection of the therapeutic spectrum in psoriasis and IBD is a very important point when choosing the management strategy for these patients. Infliximab and adalimumab are effective in the treatment of psoriasis, psoriatic arthritis, Crohn's disease, ulcerative colitis (evidence level 1A). Ustekinumab demonstrates effectiveness in the treatment of psoriasis, psoriatic arthritis (evidence level 1A) and Crohn's disease (evidence level 1B). Etanercept and secukinumab have been shown to be effective against psoriasis, psoriatic arthritis (evidence level 1A) and ineffective and even associated with exacerbation risk in Crohn's disease and ulcerative colitis. Inhibition of regulatory cytokines IL-12/23 also has a number of advantages compared to the blockade of effector cytokines (TNF-α, IL-17) due to potentially long-term and stable treatment results and less frequent administration.
Educational Impact Challenge
The goal of this activity is to increase clinicians competence in identifying patients with psoriasis who are candidates for systemic therapy and selecting appropriate therapy based on individual patient factors.
Question 1 of 5
Your patient Joe is a 25-year-old man with plaque psoriasis. He had been controlling it well with topical agents, but recent stress associated with starting a new job has likely caused a flare up, with lesions now covering about 12% of his body surface area (BSA).
Question 2 of 5
Caroline is an 18-year-old college student undergoing treatment for psoriasis on her knees, elbows, and trunk with topical and ultraviolet (UV) therapies. She presents to your clinic with bothersome new nail changes. Physical examination shows that her skin psoriasis is 11% BSA, and her nails show pitting, oncholysis, and subungual hyperkeratosis.
Question 3 of 5
Your patient Jazmine is a 55-year-old woman with psoriasis. She is currently being treated with a topical steroid, and her skin manifestations had remained steady at approximately 4% BSA. She has obesity (BMI 30.2) and is taking medications for dyslipidemia and hypertension. She presents to your clinic with a disease flare, and her BSA is now 11%.
Question 4 of 5
How confident are you right now in your ability to engage the healthcare team in shared decision-making to improve treatment of moderate to severe psoriasis with biologic therapies? (Select ranking from 1 [Not confident] to 5 [Very confident])
Question 5 of 5
Please indicate how relevant this activity is to your practice. What percentage of your patients with psoriasis are treated with a biologic agent?