title: Developments in systemic immunomodulatory therapy for psoriasis.
abstract: Psoriasis is an inflammatory skin condition that can be accompanied by joint disease. Pre-biological and biological systemic therapies are effective. Dermatologists have used systemic immunomodulators including methotrexate to treat moderate-to-severe disease for over 30 years. Pre-biological agents have toxicities and side effects that can be difficult to tolerate and require frequent monitoring. Beginning with alefacept in 2003, several biologics including cell-adhesion-molecule antagonists and cytokine antagonists such as tumor necrosis factor-blockers gained approval for psoriasis. They greatly advanced our understanding of psoriasis pathogenesis. Because they are so new, their safety is not established. Tumor necrosis factor-blockers have controversial associations with certain cancers and infections. Biologics require clinical monitoring and have specific contraindications. Scientists are exploring several new therapeutic targets.
authors.affiliation: Department of Dermatology, Tufts-New England Medical Center, Tufts University School of Medicine, Tufts-NEMC Box #114, 750 Washington Street, Boston, MA 02111, United States. emily.berger@tufts.edu
authors.forename: Emily M
authors.initials: EM
authors.lastname: Berger
authors.forename: Alice B
authors.initials: AB
authors.lastname: Gottlieb
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D001688:Biological Products / Q000009:adverse effects / Q000627:therapeutic use*; D015815:Cell Adhesion Molecules / Q000037:antagonists & inhibitors; D016207:Cytokines / Q000037:antagonists & inhibitors; D016903:Drug Monitoring; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D011565:Psoriasis / Q000188:drug therapy* / Q000276:immunology; D016032:Randomized Controlled Trials as Topic; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D001688:Biological Products; D015815:Cell Adhesion Molecules; D016207:Cytokines; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha