New synthetic pharmacotherapeutic approaches to the treatment of moderate-to-severe plaque psoriasis in adults

ABSTRACT

Introduction

Psoriasis is a chronic inflammatory and immune-mediated condition affecting 3.2% of the United States population. There are many options for psoriasis treatment including topicals, oral systemic agents, and biologics. A greater understanding of the pathophysiology of psoriasis has led to an increase in the therapeutic options for treatment.

Areas covered

In this review, we outline the novel synthetic agents for moderate-to-severe plaque psoriasis and discuss a strategy for implementing these agents in clinical practice. A literature search was performed using PubMed to identify articles relevant to the topic published before October 2022.

Expert opinion

Topicals are first-line for the treatment of moderate-to-severe plaque psoriasis, most commonly including topical steroids, vitamin D analogs, and topical calcineurin inhibitors. While new topical agents have favorable properties, they are not always effective and adherence to topical agents is poor. Biologics are safe and effective, but patients often prefer oral therapy as opposed to injectable medications. Additionally, anti-drug antibodies can reduce effectiveness of biologics over time. Oral medications are preferred, but we now have a high bar for efficacy and safety. Cost is also a barrier for many patients. Recent development of new synthetic treatment options is promising, and we recommend that providers consider these agents as they develop holistic and individualized treatment plans for their patients.

KEYWORDS:

• Synthetic
• pefcalcitol
• plaque psoriasis
• deucravacitinib
• dimethyl fumarate
• CF-101

Article highlights

• Plaque psoriasis is a common condition affecting 3.2% of the United States population.

• Improved understanding of the pathophysiology of moderate-to-severe plaque psoriasis has offered novel therapeutic targets for treatment.

• There are nine novel agents in the treatment pipeline for moderate-to-severe plaque psoriasis: MC2-01, tapinarof, roflumilast, pefcalcitol, apremilast, deucravacitinib, CF-101, tofacitinib, LAS41008.

• While topicals are considered first-line and biologics are highly effective, oral medications are preferred for many patients due to poor adherence and preference for non-injectable therapy.

• Therapeutic approaches for moderate-to-severe plaque psoriasis must be holistic and individualized with careful selection of pharmacotherapy.

Declaration of interests

S Feldman has received research, speaking and/or consulting support from Eli Lilly and Company, GlaxoSmithKline/Stiefel, AbbVie, Janssen, Alovtech, vTv Therapeutics, Bristol-Myers Squibb, Samsung, Pfizer, Boehringer Ingelheim, Amgen, Dermavant, Arcutis, Novartis, Novan, UCB, Helsinn, Sun Pharma, Almirall, Galderma, Leo Pharma, Mylan, Celgene, Ortho Dermatology, Menlo, Merck & Co, Qurient, Forte, Arena, Biocon, Accordant, Argenx, Sanofi, Regeneron, the National Biological Corporation, Caremark, Teladoc, BMS, Ono, Micreos, Eurofins, Informa, UpToDate and the National Psoriasis Foundation.

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

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

Additional information

Funding

This paper was not funded.