Small Molecules

An Overview of Emerging Therapeutic Options in the Treatment of Psoriasis

Melinda Gooderham, MD, MSc, FRCPC


Skin Therapy Letter. 2013;18(7) 

In This Article

Abstract and Introduction


Psoriasis is a chronic condition which requires ongoing management with therapies that have demonstrated favorable safety and efficacy profiles in long-term use. While biologics changed the way psoriasis is treated by providing effective targeted therapy, they are not without limitations. However, small molecules are emerging therapeutic options for the treatment of psoriasis. Several oral and topical small molecules, spanning different therapeutic classes, are proving to be promising treatment options in psoriasis. While studies to date have yielded positive results, further investigation of these agents are warranted for both safety and efficacy.


Insights into the pathogenesis of psoriasis coupled with a detailed understanding of the action of cytokines and their associated transduction pathways have yielded a number of new therapeutic targets. Psoriasis is a chronic condition and, therefore, requires ongoing management with safe and effective therapy. The introduction of biological agents has changed the way we treat psoriasis, providing more efficacious and directed therapy for this complex disease. Although excellent treatment options, biological agents have limitations: side effect profile, immunogenicity, contraindication and lack or loss of efficacy in some patients. On the horizon are new therapeutic options for patients with psoriasis: small molecules including oral Janus kinase (JAK) inhibitors, tofacitinib (CP-690,550) (Pfizer), baricitinib (LY3009104) (Eli Lilly), ASP015K (Janssen), as well as a topical agent, ruxolitinib (INCB018424) (Incyte), which is also available in an oral form. Agents from other therapeutic classes are also being investigated, including two from the phosphodiesterase 4 inhibitor class, oral apremilast (CC-10004) (Celgene) and topical AN2728 (Anacor), one from the sphingosine 1-phosphate receptor agonist class, ponesimod (ACT-128800) (Actelion), and a fumaric acid ester, dimethyl fumarate (FP187) (Forward-Pharma GmbH).