The last decade has witnessed a significant advance in the management of refractory
moderate-to-severe psoriasis. This advance is the introduction of biological therapies to
clinical practice. Three classes of biological therapies have been used. Of the first 2
classes to be introduced, the T-cell inhibitors and tumor necrosis factor (TNF)-
inhibitors, there have been differing fates with one of the T-cell inhibitors, efalizumab,
being withdrawn because of a rare, unpredictable association with a usually fatal neurological
condition, progressive multifocal leukoencephalopathy. In contrast, anti-TNF treatments
are now firmly established offering a high level of efficacy and a good safety record
across several indications, including psoriasis. A new approach involves targeting the p40
subunit, common to interleukins 12 and 23. Ustekinumab, the first drug in this class, now
offers a viable alternative to anti-TNFs in the treatment of moderate-to-severe psoriasis. In
this article, we discuss approaches that may be utilized to refine these existing therapies
and examine future therapeutic targets for biological therapies.
Semin Cutan Med Surg 29:63-66 © 2010 Elsevier Inc. All rights reserved.
The year 2010 marks 8 years since etanercept obtained approval from the Food and Drug
Administration for the treatment of psoriatic arthritis. There are 6 biologic therapies
approved by the Food and Drug Administration for the treatment of psoriasis and/or
psoriatic arthritis. These biologics are often used in patients who have received, are
receiving, or will receive in the future the traditional systemic antipsoriatics. In this article,
the currently available data on combining these therapies are reviewed.
Semin Cutan Med Surg 29:67-69 © 2010 Elsevier Inc. All rights reserved.