title: Unmet needs in the treatment of psoriasis.
abstract: Biologics have greatly improved the treatment of moderate-to-severe plaque psoriasis, as most patients are now able to achieve an initial improvement of 75% in the Psoriasis Area and Severity Index. However, only ∼20%-57% reach a 90% improvement in this measurement and responses may be lost over time. In addition, there are potential safety issues as TNF-inhibitor biologics have been associated with infections or non-melanoma skin malignancies. Here we review unmet needs with current therapies for psoriasis. We researched the medical literature to discuss new therapies in development and assess their potential to meet these needs. Several new classes of anti-psoriatic drugs are currently undergoing clinical development and potential improvements with these new therapies include attaining earlier and higher-level responses that are durable, more specific targeting of cytokines involved directly in psoriatic inflammation, and new therapies offering convenient administration. Additionally, based on results from clinical trials evaluating these new agents, it may be possible to find predictive markers that identify patients best treated with certain drug classes, those prone to lose treatment responses and patients who can discontinue treatment and remain in remission. It remains to be determined whether the promising results seen in early studies of therapies in development for psoriasis will translate into actual improvements over currently available treatment options.
authors.affiliation: Dept of Dermatology, Århus University Hospital, Århus Sygehus, P.P. Ørums Gade 11, 8000 Århus, Denmark.
authors.forename: Knud
authors.initials: K
authors.lastname: Kragballe
authors.affiliation: Dept of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Peter C M
authors.initials: PC
authors.lastname: van de Kerkhof
authors.affiliation: Dept of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Gordon
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D004351:Drug Resistance; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D020381:Interleukin-17 / Q000037:antagonists & inhibitors*; D053616:Janus Kinase 3 / Q000037:antagonists & inhibitors; D060046:Maintenance Chemotherapy; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011565:Psoriasis / Q000188:drug therapy*; D012074:Remission Induction; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D007155:Immunologic Factors; D020381:Interleukin-17; D047428:Protein Kinase Inhibitors; D014409:Tumor Necrosis Factor-alpha; D053616:Janus Kinase 3
keywords: Psoriasis Area and Severity Index; biologics; interleukin-17 blockers; interleukin-23 blockers; psoriasis; secukinumab