title: The future of biological therapies.
abstract: The last decade has witnessed a significant advance in the management of refractory moderate-to-severe psoriasis. This advance is the introduction of biological therapies to clinical practice. Three classes of biological therapies have been used. Of the first 2 classes to be introduced, the T-cell inhibitors and tumor necrosis factor (TNF)-alpha inhibitors, there have been differing fates with one of the T-cell inhibitors, efalizumab, being withdrawn because of a rare, unpredictable association with a usually fatal neurological condition, progressive multifocal leukoencephalopathy. In contrast, anti-TNF treatments are now firmly established offering a high level of efficacy and a good safety record across several indications, including psoriasis. A new approach involves targeting the p40 subunit, common to interleukins 12 and 23. Ustekinumab, the first drug in this class, now offers a viable alternative to anti-TNFs in the treatment of moderate-to-severe psoriasis. In this article, we discuss approaches that may be utilized to refine these existing therapies and examine future therapeutic targets for biological therapies.
authors.affiliation: Dermatology Centre, Salford Royal Hospital, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK. richard.warren@manchester.ac.uk <richard.warren@manchester.ac.uk>
authors.forename: Richard B
authors.initials: RB
authors.lastname: Warren
authors.forename: Christopher E M
authors.initials: CE
authors.lastname: Griffiths
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001688:Biological Products / Q000627:therapeutic use*; D003879:Dermatologic Agents / Q000627:therapeutic use*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000893:Anti-Inflammatory Agents; D001688:Biological Products; D003879:Dermatologic Agents; D007155:Immunologic Factors