Types of Biologic Drugs for Psoriasis
Anti-tumor necrosis factor (anti-TNF) drugs are one type of biologic now used for psoriasis. These were first developed as treatment for rheumatoid arthritis, Heffernan says. But TNF is a protein also involved in the development of psoriasis and psoriatic arthritis.
Examples of anti-TNF drugs are:
- Adalimumab (Humira), approved for psoriasis and psoriatic arthritis
- Etanercept (Enbrel), approved for psoriasis and psoriatic arthritis
- Golimumab (Simponi), approved for psoriatic arthritis
- Infliximab (Remicade), approved for psoriasis and psoriatic arthritis
As researchers better understand how the immune system works with psoriasis, they have developed biologics specifically for this disease. Such as:
- Ustekinumab (Stelara) targets two proteins, interleukin-12 and interleukin-23, that help regulate the immune system. Researchers believe these proteins promote inflammation linked specifically to psoriasis.
The more targeted the treatment, the greater the chance it will work and with fewer side effects, Heffernan says.
More Psoriasis Medications on the Way
Much progress has already been made, but many more drugs are being developed. Phase III clinical trials are under way for at least 10 new psoriasis drugs. This means researchers are testing these drugs with large groups of people and looking closely at their effectiveness and safety:
- 9-cis-beta-carotene, an oral beta-carotene to be combined with UVB light therapy for psoriasis.
- AMG 827, an injectable anti-inflammatory (IL-17 receptor blocker) for psoriasis.
- Apremilast, an oral anti-inflammatory (phosphodiesterase-4 inhibitor) for psoriasis and psoriatic arthritis.
- Briakinumab, an injectable anti-inflammatory (IL-12/-23 blocker) for psoriasis.
- Certolizumab pegol (Cimzia), an injectable anti-inflammatory (TNF blocker) for psoriatic arthritis. This drug is FDA approved for treatment of rheumatoid arthritis and Crohn’s disease.
- CF101, an oral anti-inflammatory (adenosine A3 receptor inhibitor) for psoriasis
- Desoximetasone, a topical anti-inflammatory (steroid) for psoriasis.
- Indigo naturalis ointment, a traditional Chinese medicine for psoriasis.
- Tofacitinib, an oral anti-inflammatory (JAK kinase inhibitor) for psoriasis and psoriatic arthritis.
- Voclosporin, an oral immune suppressant (calcineurin blocker) for psoriasis.
How are these drugs different or potentially better? Ustekinumab and briakinumab, for example, target proteins thought to promote inflammation linked specifically to psoriasis. Others, such as apremilast, make biologics available in pill form. Still others, such as voclosporin, fit into a newer class of immune suppressant, providing a next-generation calcineurin inhibitor. These types of drugs possibly disrupt the activation of T cells. But they are not as specific in their attack as biologics.
People with psoriasis now have many medications from which to choose. But it's impossible to know which drugs will work best for you -- and which will cause side effects -- until you try them. One of the big hopes for the future? With genetic studies, researchers say they hope someday to be able to predict which medication will work best in your body without harmful side effects. This kind of tailored treatment would be an incredible advance in psoriasis treatment.