IL-12/IL-23 Inhibitors: The Advantages and Disadvantages of this Novel Approach for the Treatment of Psoriasis
Psoriasis is a common chronic inflammatory skin disease that is mediated, in part by the body’s T-cell inflammatory response mechanisms. Current data regarding the efficacy of these agents show they may have the potential to become the new clinical gold standard for biologic therapy to treat psoriasis.
Patients suffering from scalp psoriasis frequently seek medical care because of the persistent discomfort due to itching and social embarrassment. This article explores some of the challenges that patients fact, current options and new advances in the topical management and strategies that may improve treatment outcomes.
This review concentrates on those drugs which have been clearly shown, or are widely reputed, to make psoriasis worse. There is insufficient clinical evidence to justify the inclusion of many drugs which have been included in published lists of drugs said to exacerbate psoriasis.
Etanercept is a tumor necrosis factor antagonist with anti-inflammatory effects. It is currently approved in the US for psoriasis, psoriatic arthritis, ankylosing spondylitis, rheumatoid arthritis and juvenile rheumatoid arthritis. Clinical trials have shown this agent to have an excellent safety profile and to be well tolerated by both adult and pediatric patients.
If methotrexate were introduced as a new drug today, it would be hailed as a major advance in the management of psoriasis, as well as for a number of other conditions. When patients are properly screened and educated about the correct use of this drug, and appropriately monitored during treatment, MTX is often very safe, simple to use, inexpensive, and well-tolerated.
Tildrakizumab is a promising therapeutic option for patients with moderate-to-severe chronic plaque psoriasis. The specificity of the drug in targeting the p19 subunit of IL-23 allows for the high efficacy and safety of long-term treatment as demonstrated in clinical trials.
Topical agents for the treatment of psoriasis are indicated for patients whose affected area is < 10% of their skin. However, for long-term use, their effectiveness can be limited. Topical sequential therapy involves the application of a class I corticosteroid and calcipotriene in three different phases.
Methotrexate has been an important agent in the management of dermatologic conditions for decades. Although first indicated for the treatment of psoriasis, MTX has been shown to be a successful treatment option for a wide array of skin diseases.
Treatments for Scalp Psoriasis with Emphasis on Calcipotriol Plus Betamethasone Dipropionate Gel (Xamiol®)
Scalp psoriasis occurs in 50%-75% of patients with plaque psoriasis. It may be the only area of the body affected, or it may be associated with disease elsewhere, including psoriatic arthritis. Most cases are treated topically, usually with steroids and/or calcipotriol.
Etanercept (Enbrel®, Amgen and Wyeth), a tumor necrosis factor (TNF) antagonist, was approved in January 2002, for the treatment of psoriatic arthritis (PsA). Etanercept was evaluated for the treatment of PsA and psoriasis in a preliminary study of 60 patients and in a confirmatory phase III study of 205 patients.
Psoriasis is thought to arise from a combination of pathogenic factors including genetic susceptibility and environmental exacerbation. This article reviews the current status of guselkumab as a therapy for moderate-to-severe plaque psoriasis.
A novel fixed combination lotion containing the super-potent corticosteroid halobetasol propionate 0.01% and retinoid tazarotene 0.045% (Duobrii™) has recently been introduced and indicated for the treatment of moderate to severe plaque psoriasis in adults.
Psoriasis, acne vulgaris and photoaging are common conditions. Tazarotene is a pro-drug of tazarotenic acid, a receptor-selective retinoid, which has shown efficacy in the treatment of these disorders. In the treatment of acne vulgaris, it has greater comedolytic activity than the currently available topical retinoids.
The addition of biologics that target IL-23p19 (Risankizumab) to our therapeutic armamentarium has succeeded in improving outcomes in patients with moderate-to-severe plaque psoriasis.
Alcohol is a serious cause of morbidity and mortality in our society and is implicated in multiple health conditions, including hepatic failure, neurological damage, and hematological disorders. Herein, we review the evidence concerning the influences of alcohol in skin conditions.
A novel topical corticosteroid, halobetasol propionate (HP) 0.01% lotion (Bryhali™), has recently been introduced for the treatment of plaque psoriasis and corticosteroid-responsive dermatoses in adults.
Scalp conditions such as itchy scalp, dandruff, seborrheic dermatitis, and scalp psoriasis are common. The emotional effect these complaints cause are often ignored or trivialized, but as dermatologists we should appreciate the relief that appropriate advice and treatment will bring to our patients.
Psoriasis is a chronic immune-mediated inflammatory disease with epidermal hyperplasia. Interleukin (IL)-17 signaling has a central role in its pathogenesis, and is being looked at as a target. The rationale for IL-17 inhibitors, clinical trial results of new drugs like Brodalumab are included.
A fixed combination halobetasol propionate and tazarotene lotion (HP/TAZ) was launched in Canada in 2020, to treat moderate to severe plaque psoriasis in adults. With the use of polymeric emulsion technology, there is uniform distribution of HP and TAZ and excipients on the skin and improved skin moisturization.
This article discusses the role that dermatologists can play in recognizing the cutaneous manifestations linked with some systemic conditions. Identifying the underlying disorder will contribute to appropriate diagnosis and improved management.
Acitretin (SORIATANE®, Roche Pharmaceuticals) is an aromatic retinoid, effective in the treatment of severe psoriasis. This study highlights data from two existing clinical trials to capture PASI 50 and PASI 75 responder rates which represent a common metric used in current psoriasis clinical trials.
With growing public reluctance to use systemic medications we can expect topical treatments for psoriasis and other skin conditions to become increasingly important in the future. These drugs are useful not only to control this disease, but also to limit the irritation caused by medications such as tazarotene and anthralin.
Approximately 50% of patients with psoriasis have nail psoriasis but the life time chance of nail changes must be much higher. Nail changes in psoriasis include pitting, thickening, onycholysis, discoloration, oily spots, splinter hemorrhages and paronychia. Treatment of choice depends on the form the psoriasis takes.
Many aspects of psoriasis remain a mystery - but one that is slowly becoming revealed. Various immunobiological treatments for psoriasis are covered in this article.
Psoriasis is a chronic inflammatory cutaneous disorder that can significantly affect patient quality of life (QoL). This article discusses immunologic abnormalities, immune mediators, and the possible pathogenesis of psoriasis.
While biologics changed the way psoriasis is treated by providing effective targeted therapy, they are not without limitations. Small molecules are emerging therapeutic options for the treatment of psoriasis.
Biologics are one of the more effective and relatively safe options for long-term control of psoriasis. They have reduced the time needed to clear the signs of chronic disease, and are effective in maintaining a disease-free state for longer durations. Biologics can safely be used with other treatment modalities (i.e., methotrexate, cyclosporine, acitretin and hydroxyurea).
Psoriasis types and subtypes can influence preferred treatment modality. This article discusses the symptoms specific to the psoriasis subtype, and considerations for selecting treatment.
Pregnancy is characterized by multiple physiologic changes. Herein, we review the complicated relationships between psoriasis and pregnancy.
Psoriasis is a common dermatosis, affecting children in North America. Many papers have stressed the treatments available for adult psoriasis, but few have dealt with this disorder in children. Topical treatment modalities continue to be the first line therapy for childhood psoriasis.
Tofacitinib is an oral immunosuppressant approved for the treatment of rheumatoid arthritis (RA) and is currently undergoing investigation (Phase III trials) for treating chronic plaque psoriasis.
Certolizumab Pegol appears to offer a safe and effective psoriasis treatment for patients who are considering pregnancy, pregnant, or lactating based on its pharmacokinetics and available safety data.
Although PDT remains an investigational treatment modality in dermatology, several important areas of development may ultimately lead to official and practical acceptance of PDT for the skin. Various uses of PDT are evaluated.
Psoriasis is associated with comorbidities that include metabolic syndrome and increased cardiovascular risk. These conditions share etiologic features and health consequences that directly correlate with the severity of psoriatic disease.
Several variants of psoriasis are seen in children, the most prevalent types include plaque, guttate, and psoriatic diaper rash; pustular and erythrodermic psoriasis are less frequently observed. This article discusses genetic susceptibility, and environmental triggers are discussed.