New Therapies for Psoriasis and Psoriatic Arthritis

Christopher T. Ritchlin; James G. Krueger


Curr Opin Rheumatol. 2016;28(3):204-210. 

In This Article


The array of treatment options for psoriasis and PsA unveiled over the past several years offer new hope for patients with psoriatic disease. The tremendous impact on therapeutic response is most evident in psoriasis, whereas agents in the interleukin-23-interleukin-17 pathway induce marked plaque clearance. The results in PsA for these agents are similar to those observed with anti-TNF agents; however, the safety signals from these compounds are not concerning and may offer an advantage for many patients. Interleukin-17 blockade is also effective for axial disease and inhibits radiographic progression. The reports of suicidal behavior with the interleukin-17 receptor antagonist was not anticipated and no plausible mechanism has been identified. These reports point to the complexity of the interleukin-23-interleukin-17 signaling pathway. In regard to oral agents, apremilast offers a modest response in the skin and joints with few safety signals and routine safety monitoring is not required – a major advantage for many patients. Apremilast is not indicated in patients who demonstrate radiographic damage or axial involvement. The role of tofacitinib in psoriasis remains to be established based largely on potential safety concerns and we await data on efficacy in PsA. The rapid development of successful targeted strategies for the treatment of psoriasis and PsA illustrates overlapping disease pathways and underscores the tremendous value and impact of translational immunology research.