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Biological treatments for psoriasis

Sanjay M Rajpara, Anthony D Ormerod and Pick N Woo

Psoriasis is a chronic disease with significant morbidity and particularly severe effects on a patient’s quality of life. Topical treatments are usually effective in cases of limited psoriasis. Patients with severe disease require systemic medicines or ultraviolet light treatment in order to obtain symptomatic relief. Until recently, the available systemic medicines have been immunological agents such as cyclosporin, methotrexate, hydroxycarbamide, fumaric acid esters, ultraviolet light treatment with or without psoralens and antiproliferative agents such as retinoids. All of these treatments are associated with side effects, the severity of which increases with increasing duration of use. There has always been a lack of highly effective treatment. There has recently been expansion in the knowledge of the role of the immune system and in particular T cells in the pathogenesis of psoriasis. This has led to development of selective immunologically directed treatments for the psoriasis widely known as ‘biologicals’. This article will review the currently used biological treatments for psoriasis. Alefacept, efaluzumab, infliximab and etanercept are all biologicals that have been in use in recent years in the treatment of psoriasis, and have gained EU and/or US approval. The immunopathogenesis of psoriasis, mechanism of action of the biologicals and the overall efficacy and side effects of individual drugs will be discussed herein.