Long-term efficacy of biologics in the treatment of psoriasis: what do we really know?

Abstract

Psoriasis is a chronic inflammatory condition that often requires life-long treatment. Conventional therapies have not fully met the needs of psoriatic patients, because of limited efficacy, adverse effects with cumulative use, and patient inconvenience. In the past decade, biologic immunotherapies have become accepted treatments for psoriasis as a result of perceived efficacy and safety on the part of patients and practitioners. However, most data on these medications come from relatively limited short-term trials. In this review, we will focus on the available long-term data on the efficacy of the biologic agents. We will emphasize the strengths and weakness of the available data of the biologic agents that are Food and Drug Administration (FDA)-approved for the treatment of moderate to severe psoriasis (alefacept, efalizumab,* etanercept, infliximab, and adalimumab), with the inclusion of a newer agent currently under FDA evaluation (ustekinumab).

Long-term safety experience of ustekinumab in patients with moderate to severe psoriasis (Part II of II): Results from analyses of infections and malignancy from pooled phase II and III clinical trials

“…1 Recently, biologic agents have emerged as therapeutic options that may not be associated with cumulative toxicities, although more data are needed to understand the long-term safety of these agents. 2 Ustekinumab (Stelara, Janssen Biotech Inc, Horsham, PA), a fully human monoclonal antibody directed against the shared p40 subunit of interleukin (IL)-12 and IL-23, was demonstrated to be highly efficacious and generally well tolerated in treating patients with moderate to severe psoriasis with up to 1.5 years of therapy. [3][4][5][6][7] Theoretical risks of pharmacologic blockade of IL-12 and IL-23 include susceptibility to infection 8 and malignancy.…”

Immunological and histological evaluation of clinical samples from psoriasis patients treated with anti-CD6 itolizumab

“…Therefore, the search for new biological drugs against specific targets of the disease continues. 6 Biological agents such as the monoclonal antibodies (mAbs) infliximab and adalimumab, both of which target tumor necrosis factor (TNF), and the anti-interleukin (IL)-12/IL-23 ustekinumab, as well as the TNF receptor-Fc fusion protein etanercept, provide options for patients with moderate-to-severe psoriasis that could be safer than the administration of methotrexate (MTX) and cyclosporine. 4 The excessive proliferation and abnormal differentiation of keratinocytes and an aberrant response of T cells are the hallmarks of psoriasis, with the involvement of dendritic cells and inflammatory cytokines in its pathogenesis.…”

Peptides and Peptidomimetics as Immunomodulators

“…Several cytokines, expressed in keratinocytes of patients with psoriasis, have been recognized as inducing epidermal proliferation and inflammatory cell chemotaxis [52,53]. TNF-α targeted therapies with antibodies have proven to be efficacious in several clinical aspects of psoriasis [54]. However, such therapies resulted in side effects such as the incidence of serious infections (tuberculosis and neoplasms).…”