Treating moderate to severe psoriasis – best use of biologics

Abstract

This review focuses on the efficacy, safety and best use of biologic agents in moderate-to-severe psoriasis. Recommendations from two recent guidelines are summarised. The NICE Guidelines 2012 provide recommendations on best practice for prescribing biologics. The German S3 Guidelines are based on a systematic review of published studies and report the efficacy of biologics and guidelines for treatment. Data on the safety of biologics are available for up to 5 years in psoriasis and are on the whole reassuring. Registry data is evolving and will provide data on safety to help inform long-term monitoring of patients with psoriasis on biologics agents. New anti-interleukin-17 (IL17) and anti-IL17RA biologics are in Phase 3 clinical trials and may prove to be more effective than existing biologics.

Keywords::

• biologics
• efficacy
• psoriasis
• registries
• safety

Financial & competing interests disclosure

M Lynch is in receipt of an unrestricted research grant from Merck-Sharp-Dohme. In the last 3 years, B Kirby is in receipt of unrestricted research grants from Pfizer, Abbvie, Janssen Cilag. B Kirby is a principal investigator for clinical trials for Abbvie, Janssen Cilag, Novartis and Merck-Sharp-Dohme. B Kirby has acted as a consultant/advisory board member for Pfizer, Abbvie, Janssen Cilag, Novartis and Roche. RB Warren has acted as a consultant and/or speaker for Abbott (now Abbvie), Janssen Cilag, Leo Pharma, Pfizer, Novartis and Schering-Plough (now MSD), all of whom manufacture therapies used in the treatment of psoriasis. He has received unrestricted grant support from Abbvie, Leo and Pfizer. 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.

No writing assistance was utilized in the production of this manuscript.

Key issues

• There is an unmet need among patients with severe psoriasis for systemic and biologic therapies.

• The use of comprehensive and updated guidelines by physicians, based on the highest quality of evidence available, such as the recent NICE 2012 or the German S3 guidelines, is essential for safe and effective prescribing.

• Long-term data from open-label extension studies demonstrate the safety of biologics up to 5 years, but real-life data from registries will give a true reflection of the efficacy and safety of biologics in their main target population.

• Newer biologic agents are in Phase III clinical trials including anti-IL-17 and anti-IL-17RA agents with a narrower spectrum of action than anti-TNF agents and promising efficacy.