What new biologic treatments are available for treating psoriasis?

From the Guidelines

Biologic treatments such as TNF-alpha inhibitors, IL-17 inhibitors, IL-23 inhibitors, and the IL-12/23 inhibitor ustekinumab are now available for treating psoriasis, offering effective options for patients with moderate to severe disease. The main classes of biologic treatments include:

• TNF-alpha inhibitors (adalimumab, etanercept, certolizumab pegol, and infliximab) 1
• IL-17 inhibitors (secukinumab, ixekizumab, and brodalumab) 1
• IL-23 inhibitors (guselkumab, risankizumab, and tildrakizumab) 1
• The IL-12/23 inhibitor ustekinumab 1 These medications are typically administered by subcutaneous injection every 1-12 weeks depending on the specific drug, with most requiring initial loading doses followed by maintenance dosing. For example, secukinumab is given as 300mg injections weekly for five weeks, then monthly thereafter 1.

Key Considerations

• Biologics target specific inflammatory pathways involved in psoriasis pathogenesis, providing more targeted therapy than traditional systemic treatments 1
• IL-17 and IL-23 inhibitors generally demonstrate the highest efficacy, with 70-90% of patients achieving significant skin clearance 1
• These medications require prior screening for tuberculosis and other infections, and patients should be monitored for potential side effects including injection site reactions, upper respiratory infections, and rarely, more serious adverse events 1
• Biologics are typically reserved for patients who have failed topical therapies and conventional systemic treatments, or those with extensive disease requiring rapid and effective control 1

From the FDA Drug Label

The text does not directly mention new biologic treatments available for treating psoriasis, but it does mention risankizumab (SKYRIZI) as a treatment for plaque psoriasis. The biologic treatment mentioned in the text is risankizumab (SKYRIZI), which is used to treat plaque psoriasis.

• The studies mentioned in the text, such as PsO-1 and PsO-2, demonstrate the efficacy of risankizumab in treating plaque psoriasis.
• The text does not provide a comprehensive list of new biologic treatments for psoriasis, but rather focuses on the specific treatment of risankizumab. 2 2

From the Research

New Biologic Treatments for Psoriasis

• Several new biologic treatments are available for treating psoriasis, including IL-17 inhibitors (secukinumab, ixekizumab, and brodalumab) and IL-23 inhibitors (guselkumab, tildrakizumab, and risankizumab) 3.
• These treatments have shown increasing effectiveness compared to previous biological therapy and a good safety profile 3.
• The choice of biologic treatment depends on various factors, including comorbidities, as some treatments can influence comorbidities and even improve them 4.

IL-23 Inhibitors

• Risankizumab is a fully human IgG monoclonal antibody inhibitor of IL-23, which has been developed for the treatment of moderate-to-severe plaque psoriasis 5.
• Risankizumab has shown high efficacy and a good safety profile in clinical trials, and its FDA-approval in 2018 is likely 5.
• Switching to risankizumab after failure of other IL-23 inhibitors, such as guselkumab, can be an effective treatment option for patients with moderate-to-severe psoriasis 6, 7.

Treatment Outcomes

• Patients treated with risankizumab after guselkumab failure have shown significant improvements in static physicians' global assessment (sPGA) scores 6.
• IL-23 intraclass switching, including switching from guselkumab or tildrakizumab to risankizumab, can be an effective treatment strategy for patients with moderate-to-severe psoriasis who have experienced loss of efficacy to any IL-23 inhibitor 7.
• The majority of patients who underwent IL-23 intraclass switching achieved an affected body surface area (BSA) < 1% after switching, with significant improvements in BSA scores 7.