Biologics have become a well-established treatment for psoriasis, especially in those patients with moderate to severe plaque psoriasis who cannot be controlled on topical therapies. The go-to biologics were initially the tumor necrosis factor-alpha (TNF) inhibitors. Remicade (infliximab), Enbrel (etanercept), Humira (adalimumab) and Cimzia (certolizumab pegol) are the biologics in this category.
What are the IL-17 blockers for psoriasis?
The next category of biologics for psoriasis were the IL-17 blockers. These include Cosentyx (secukinumab), Talz (ixekizumab) and Siliq (brodalimumab).
What are the IL-23 blockers for psoriasis?
Stelara (ustekinumab) blocks the p40 subunit of both IL-23 and Il-12. IL-23 and IL-12 share a common subunit. IL-23 is distinguished by its p19 subunit. The newest IL-23 blockers are specific for the p19 subunit. IL-23 in turn induces Th17 cells and the cytokines IL-17 and IL-22, which are implicated in the pathogenesis of psoriasis. Tremfya (gesulkamab) and Ilumya (tildrakizumab) are the two currently approved p19 blockers, with more new IL-23 blockers in development.
Tremfya is administered subcutaneously at week 0, week 4 and then every 8 weeks. Ilumya has very convenient dosing of week 0, week 4, and then every 12 weeks.
The Il-23 blockers have excellent efficacy at 16 week follow-up, and an excellent safety profile.
These newer biologics can be considered for psoriasis patients eligible for systemic therapy.
Can biologics be used with other psoriasis treatments?
Topical medications and UVB light or laser therapy can be used in conjunction with biologics.
