Risks of Biologic Therapy and the Importance of Multidisciplinary Approach for an Accurate Management of Patients with Moderate-Severe Psoriasis and Concomitant Diseases

Abstract

Psoriasis is a chronic multisystem inflammatory disease associated with a plethora of comorbidities including metabolic syndrome, cardiovascular disease, hypertension, diabetes, hyperlipidemia, obesity, anxiety, depression, chronic kidney disease, and malignancy. Advancement in unveiling new key elements in the pathophysiology of psoriasis led to significant progress in the development of biologic agents which target different signaling pathways and cytokines involved in the inflammatory cascade responsible for the clinical manifestations found in psoriasis. Currently available novel therapeutic options for moderate-severe psoriasis include tumor necrosis factor alpha inhibitors, inhibitors of the interleukin 17, and inhibitors of the interleukin 23. Nevertheless, concerns have been raised with respect to the possible risks associated with the use of biologic therapy requiring close collaboration between dermatologists and physicians of different specialties. Our aim was to perform an in-depth literature review and discuss the potential risks associated with biologic therapy in patients with psoriasis and concurrent diseases with a focus on the influence of novel therapeutic agents on liver function in the context of hepatopathies, particularly viral hepatitis. A multidisciplinary teamwork and periodic evaluation of psoriasis patients under biologic therapy is highly encouraged to obtain an accurate management for each case.

An Insight on the Possible Association between Inflammatory Bowel Disease and Biologic Therapy with IL-17 Inhibitors in Psoriasis Patients

“…An in-depth understanding of the pathophysiology of psoriasis led to significant advances in the development of safe and efficient novel therapeutic options, with four classes of biologic therapy being approved for the management of moderate to severe psoriasis: TNF-α inhibitors, anti-IL-23 agents, anti-IL-12/23 agents, IL-17 inhibitors, as well as small-molecule inhibitors, such as apremilast, as presented in Table 1 [26]. Nevertheless, in many instances, the concomitant diseases associated with psoriasis greatly impact the clinical decision of selecting one therapeutic class over another [26,27]. Therefore, when planning an individualized therapeutic approach, it is recommended to carefully take into consideration which biologic agent improves or exacerbates a certain comorbidity for each patient, as presented in Table 2 [26].…”

“…Nevertheless, in many instances, the concomitant diseases associated with psoriasis greatly impact the clinical decision of selecting one therapeutic class over another [ 26 , 27 ]. Therefore, when planning an individualized therapeutic approach, it is recommended to carefully take into consideration which biologic agent improves or exacerbates a certain comorbidity for each patient, as presented in Table 2 [ 26 ].…”

Immune Portrayal of a New Therapy Targeting Microbiota in an Animal Model of Psoriasis

“…Studies developed on psoriatic patients have shown that therapies addressing signaling pathways and cytokines can affect also the concurrent diseases of the patient [4]. The gutskin axis functions both ways, as the imbalanced gut microbiome can modulate the clinical outcome of PSO.…”