Pharmacodynamics OF TNF α inhibitors for the treatment of psoriasis

ABSTRACT

Introduction: The treatment of psoriasis with conventional topical therapies and disease-modifying anti-rheumatic drugs (DMARDs) is often linked to unsatisfactory outcomes and the risk of serious adverse events. Over the last decades, research advances in understanding the role of tumor necrosis factor alpha (TNF α) and other cytokines in the pathogenesis of psoriasis have driven the introduction of biologic agents targeting specific immune mediators in everyday clinical practice. TNF α inhibitors are a consolidated treatment option for patients with moderate-to-severe disease with remarkable efficacy and a reassuring safety profile.

Areas covered: The PubMed database was searched using combinations of the following keywords: psoriasis, TNF α inhibitors, biologic therapy, pharmacodynamics, adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, adverse effects. The aim of this review is to describe the pharmacodynamic profile of anti-TNF α inhibitors, currently approved by the European Medicines Agency (EMA) for the treatment of psoriasis, focusing on related clinical implications, also in comparison to the new generation biological therapies targeting the interleukin 23/interleukin 17 axis.

Expert opinion: Pharmacodynamics of TNF α inhibitors should be fully considered in planning patient’s therapy strategies, especially in case of secondary failures, poor adherence to treatment, instable psoriasis, high risk of infection, pregnant or lactating women, metabolic comorbidities, coexistence of other immune-mediated inflammatory diseases.

KEYWORDS:

• Psoriasis
• TNF-alpha inhibitors
• biologic therapy
• pharmacodynamics
• adalimumab
• etanercept
• infliximab
• certolizumab pegol
• golimumab
• adverse effects

Article highlights

• TNF alpha is a crucial cytokine in the pathogenesis of several chronic inflammatory diseases including psoriasis and other comorbidities often associated with psoriatic disease.

• TNF alpha inhibitors were the first biologic drugs approved for the treatment of psoriasis and they represent a consolidated option for patients with moderate-to-severe disease with remarkable efficacy and a reassuring safety profile.

• Although sharing the same target, each anti-TNF alpha inhibitor possesses structural and pharmacodynamics peculiarities. The knowing of them represents an important discriminating factor in driving clinicians to individualize treatment in every clinical setting, also because different pharmacodynamics imply different adverse events.

• Despite the introduction of newer biologic drugs targeting interleukin-23/interleukin-17 axis, anti-TNF alpha agents are still a feasible option for patients with psoriasis and other relevant comorbidities.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer of this manuscript has declared being an employee of Mount Sinai and receiving research funds from: Abbvie, Boehringer Ingelheim, Celgene, Eli Lilly, Incyte, Janssen/Johnson & Johnson, Leo Pharmaceuticals, Medimmune/Astra Zeneca, Novartis, Pfizer, Sciderm, Valeant, and ViDac.

The same reviewer is also a consultant for Allergan, Aqua, Boehringer-Ingelheim, LEO Pharma, Menlo, Mitsubishi, Promius and Theravance.

Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.