COMMENTARY

Psoriasis Treatment With Biologics: 5 Things to Know

Caitlin G. Purvis; Steven R. Feldman, MD, PhD

Disclosures

June 14, 2021

Psoriasis affects at least 100 million people worldwide, with plaque psoriasis (also referred to as psoriasis vulgaris) being the most common form. Although many different medication options are available for psoriasis, the type of treatment prescribed is chosen on the basis of severity and percentage of body surface area (BSA) affected (eg, mild, moderate, moderate to severe, or severe disease). Moderate psoriasis involves 3%-10% of the BSA, while severe psoriasis involves greater than 10%. For moderate to severe psoriasis, the American Academy of Dermatology and National Psoriasis Foundation Guidelines recommend systemic treatments, including biologic agents.

The development of several biologic agents over the past decade has dramatically changed the treatment landscape for patients with psoriasis. Biologic agents are engineered monoclonal antibodies and fusion proteins that block the specific cytokines or their receptors that mediate the inflammation seen with psoriasis. To date, 11 biologic agents are approved by the US Food and Drug Administration (FDA) for psoriasis. A recent meta-analysis of treatments for moderate to severe psoriasis suggests that biologics (specifically brodalumab, guselkumab, ixekizumab, and risankizumab) have a superior response rate compared with other treatments (eg, oral medications). Because adequate head-to-head comparison data are limited, determining which treatment option is best for your patients can be challenging.

Here are five things to know about treatment of psoriasis with biologics.

1. Be sure to evaluate for comorbid conditions, especially concomitant joint pain.

Plaque psoriasis and other forms of skin psoriasis typically precede the onset of psoriatic arthritis (PsA); approximately 25% of psoriasis patients have concurrent PsA. The Psoriasis Epidemiology Screening Tool (PEST) can be used to screen patients for PsA. Physicians should discuss the association between psoriasis and PsA with patients and evaluate them for wrist, sacroiliac, and ankle inflammatory arthritis, as well as dactylitis, enthesitis, nail pitting, and onycholysis.

When treating patients who have psoriasis and PsA, some physicians choose biologics approved to treat both of these conditions. However, some treatments approved only for plaque psoriasis could also be effective in treating symptoms of PsA. Tumor necrosis factor alpha inhibitors (adalimumab, infliximab, certolizumab pegol, etanercept), interleukin (IL) 17 inhibitors (ixekizumab, secukinumab), IL-12/23 inhibitors (ustekinumab), and IL-23 inhibitors (guselkumab) are all FDA-approved for PsA.

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