The safety of anti-interleukins monoclonal antibodies for the treatment of psoriasis

ABSTRACT

Introduction: Psoriasis is a chronic inflammatory disease and affects about 10% of the world's population. Psoriasis is associated with a number of comorbidities. Biologic therapies for the treatment of moderate-severe plaque psoriasis include tumor necrosis factor α inhibitors (TNFi), and newer molecules targeting IL-12 and 23, blocking p40 subunit, or targeting subunit p19 of IL-23 and other molecules blocking IL-17A, or directed against the IL-17 receptor.

Areas covered: Anti-interleukin drugs show great improvement in disease control and on the other hand are not affected by important adverse reactions of older compounds. Approach to chronic disease affected patients, in particular, and to patients with multiple comorbidities is revolutionized by novel molecules that are safer and more manageable.

Expert opinion: A recent work suggests that pro-fibrogenic cytokines, IL-17, might be important player of liver damage and even in regulation of obesity, diabetes, and non-alcoholic fatty liver disease (NAFLD) pathogenesis. Choosing to interfere with IL-23/Il-17 axis, definitely, is like acting against psoriatic march and in a parallel way against its comorbidities.

KEYWORDS:

• Biologic therapies
• IL-17
• IL-23
• IL-12
• interleukins inhibitors
• safety

Article highlights

• Psoriasis is known to be a complex disease in which the alteration of the IL-23/Th17 axis appears to be crucial for its pathogenic mechanisms and its treatment with new anti-interleukins drugs could solve more problems with only one action, acting against psoriatic march and in a parallel way against its comorbidities.

• New anti-interleukins drugs, approved for the treatment of chronic plaque psoriasis, are safe according to a low rate of adverse events. Clinicians could manage these compounds more easily than anti-TNFs, especially in patients with comorbidities and potentially at risk for chronic disease.

• Better efficacy results in comparison to anti-TNFα are widely documented in studies, even for anti–IL-23 and for anti–IL-17.

• Anti-interleukins are not proven to have rigid contraindication in patients with a history of latent tuberculosis infection.

• Increased risk of Candida infections, worsening of pre-existing inflammatory bowel disease and, rarely, new-onset ulcerative colitis and Crohn’s disease have been reported during treatment with IL-17 inhibitors.

• Selectively targeting IL-23p19 appears to avoid adverse events that have been associated with biologic agents with other mechanisms of action, with no signals for elevated risk of opportunistic infections, tuberculosis, mucocutaneous Candida infections, de novo onset or potential exacerbation of inflammatory bowel disease or demyelinating disorders observed to date.

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Declaration of interest

L Bianchi has served as a speaker and a consultant for AbbVie, Novartis, Janssen-Cilag, Pfizer, UCB, Leo-Pharma outside the submitted work. 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 received research, speaking and/or consulting support from Advance Medical, Almirall, Alvotech, Abbvie, BMS, Boehringer Ingelheim, Caremark, Celgene, Eli Lilly, Galderma, GSK/Stiefel, Incyte, Informa, Janssen/Johnson & Johnson, Leo Pharmaceuticals, Menlo, Merck, Mylan, Medimmune/Astra Zeneca, Novan, Novartis, Ortho Dermatology, Pfizer, Qurient, National Biological Corporation, National Psoriasis Foundation, Regeneron, Sanofi, Samsung, Sciderm, Sun Pharma, Suncare Research, UpToDate, Valeant and ViDac, and they are a consultant for Allergan, Aqua, Boehringer-Ingelheim, LEO Pharma, Menlo, Mitsubishi, Promius and Theravance. A peer reviewer on this manuscript has disclosed that they consult through Guidepoint Global, Gerson Lehrman, and other consulting organizations. Peer reviewers on this manuscript have disclosed that they are the founder and majority owner of www.DrScore.com, and the founder and part owner of Causa Research.

Additional information

Funding

This paper has not been funded.