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being withdrawn because of a rare, unpredictable association with a usually fatal neurological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 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being withdrawn because of a rare, unpredictable association with a usually fatal neurological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.