Choosing the right biologic treatment for moderate-to-severe plaque psoriasis: the impact of comorbidities

ABSTRACT

Introduction

Psoriasis is a chronic inflammatory skin disease often associated with several comorbidities, such as psoriatic arthritis, inflammatory bowel disease, obesity, diabetes mellitus or cardiovascular diseases, infections, or cancer, among others. With the progressive aging of the population, a growing number of patients with psoriasis can be expected to present multiple comorbidities. Currently, there is a wide range of biological treatments available for moderate to severe psoriasis, including tumor necrosis alpha (TNF) inhibitors, IL12/23 inhibitor, IL17 inhibitors, and IL23 inhibitors.

Areas covered

This review aims to describe the specific characteristics of these drugs in relation to psoriasis comorbidities, in order to facilitate decision-making in clinical practice.

Expert opinion

Some of the biological treatments can influence comorbidities, in some cases even improving them. Therefore, comorbidities are a key factor when deciding on one biological treatment over another. The development of new drugs is expanding the therapeutic arsenal for psoriasis. A high level of expertise in the field with a detailed knowledge of the characteristics of every drug is imperative to provide personalized medicine.

KEYWORDS:

• Psoriasis
• comorbidities
• biologic treatment
• TNF inhibitors
• IL17 inhibitors
• IL23 inhibitors
• ustekinumab

Article highlights

• Comorbidities have to be taken into account when selecting the biologic treatment for moderate-to-severe plaque psoriasis.

• TNF inhibitors are contraindicated in patients with congestive heart failure.

• TNF inhibitors are not recommended in cases of demyelinating and autoimmune diseases.

• TNF inhibitors and ustekinumab are associated with increased risk of reactivation of tuberculosis, viral and intracellular infections.

• IL17 and IL23 inhibitors may be associated with a decreased risk of several malignancies.

• IL17 inhibitors can worse or trigger an inflammatory bowel disease. Thus, they are not recommended in patients with inflammatory bowel disease.

Declaration of interest

L Puig has received honoraria for serving on advisory boards’ and speakers’ bureaus or for consulting and institutional grants for investigator activities sponsored by Abbvie, Almirall, Amgen, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Dice, Janssen, Leo-Pharma, Lilly, Novartis, Pfizer, Sandoz, Sanofi, and UCB. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

A reviewer on this manuscript has disclosed receipt of payment for advisory boards, lectures, or clinical trials with Abbvie, Allmirall, Boehringer, Celgene, Janssen, Leo, Lilly, Novartis, and UCB. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.