New therapies versus first-generation biologic drugs in psoriasis: a review of adverse events and their management

ABSTRACT

Introduction: Biologic drugs have revolutionized the treatment of moderate to severe psoriasis in recent years because of their high efficacy and low risk of toxicity. However, even within the group of biologic therapies, there are differences related to the different mechanisms of action.

Areas covered: We review the main adverse events associated with the biologic agents currently available for the treatment of psoriasis and the new inhibitors targeting the p19 subunit of interleukin (IL) 23 and the IL-17A receptor. This review covers injection site reactions, infections, cardiovascular events, demyelinating disorders, tumours, class effects secondary adverse events, immunogenicity, safety in pregnancy and vaccines efficacy.

Expert commentary: More than a decade after the first approval of biologic drugs for use in psoriasis, the good safety profile of these drugs is one of the main justifications and incentives for their long-term use. The emergence of new pharmacological groups has made it possible to avoid some of the class effects of first-generation biologic agents and the new therapies appear to pose less risk of reactivation of latent infections, such as hepatitis B virus and tuberculosis. However, they are associated with new adverse effects related to their mechanism of action, including candidiasis and the risk of exacerbation or onset of inflammatory bowel disease.

KEYWORDS:

• Adverse event
• biologics
• IL-17 inhibitors
• IL-23 inhibitors
• psoriasis
• safety
• tumour necrosis factor-inhibitor

Declaration of interest

JM Carrascosa has been a speaker and/or advisor and/or has participated in clinical trials for Celgene, Janssen, Lilly, Novartis, Leo Pharma, Pfizer, MSD, Abbvie, Biogen and Amgen. E del Alcazar has been a speaker and/or advisor or has received grants from Abbvia, Janssen, Novartis and Leo Pharma. 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. One peer reviewer on this paper has been a clinical investigator for all molecules discussed in the paper. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Additional information

Funding

This article was funded by Germans Trias i Pujol Research Institute.