Title:An Evidence-Based Review of the Mechanism of Action, Efficacy, and Safety of Biologic Therapies in the Treatment of Psoriasis and Psoriatic Arthritis
Volume: 22
Issue: 16
Author(s): Elizabeth A. Brezinski and April W. Armstrong
Affiliation:
Keywords:
Adalimumab, biologics, certolizumab pegol, etanercept, golimumab, infliximab, psoriasis, psoriatic arthritis, review,
ustekinumab.
Abstract: Biologic agents have expanded the repertoire of efficacious and safe systemic therapies for
the treatment of moderate-to-severe psoriasis and active psoriatic arthritis. The biologics act to inhibit
key inflammatory molecules that are thought to be involved in the pathogenesis of these chronic inflammatory
disorders as well as physiologic immune responses. In this paper, we discuss the proposed
molecular mechanisms of action, efficacy, and safety of the two FDA-approved classes of biologics,
the tumor necrosis factor inhibitors and the interleukin-12/23 inhibitor. The tumor necrosis factor inhibitors
that are reviewed include etanercept, infliximab, adalimumab, golimumab, and certolizumab pegol. The interleukin-
12/23 inhibitor that is discussed is ustekinumab. Specifically, we review the mechanism of action for each biologic
agent and the FDA-approved indications and dosing for these therapeutics. We provide up-to-date evidence for the efficacy
of these systemic medications using key phase 3 clinical trial data, we highlight important safety information for
each biologic based on long-term open-label extension trials and safety registries, and we discuss studies that investigate
off-label dosing with the biologics. Each biologic is reviewed in these specific areas of focus for their indicated treatment
of psoriasis and/or psoriatic arthritis.