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?
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.
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.