Emerging therapies for the treatment of psoriasis

Efficacy and safety of treatment of moderate and severe psoriasis with the interleukin 23 inhibitor risankizumab

A review of the literature on the use of the genetically engineered biological drug Skyrizi (INN: risankizumab) for the treatment of psoriasis in patients is presented. The problem of high dissatisfaction of patients with the available means (methods) of therapy for this dermatosis is discussed. Inhibition of regulatory IL-23 seems to be a very promising direction of therapy, which makes it possible to block the immunopathogenesis of the disease. The IL-23 inhibitor risankizumab is a highly effective GEBA for the treatment of moderate to severe psoriasis in patients. The use of this drug is accompanied by a very rapid and stable therapeutic response in the form of clear or almost clear skin. Long-term use of risankizumab demonstrates the maintenance of a stable therapeutic response without a tendency to decrease. Risankizumab has a favorable safety profile with a low risk of infections and malignancies. At the same time, such adverse events as the development of tuberculosis or inflammatory bowel disease are not typical for therapy with these GIBDs.

Use of active metabolites of vitamin D orally for the treatment of psoriasis

OBJECTIVE

The objective of this study was to analyse the existing bibliographic production on clinical trials related to the use of vitamin D for oral treatment of psoriasis.

METHOD

A literature review of clinical trials related to the use of vitamin D for oral treatment of psoriasis, published in the LILACS, Scielo, Medline, PubMed and Cochrane Library from 1986 to 2013. The search included the following terms: "Psoriasis and oral Vitamin D"; "psoríase e vitamina D oral".

RESULTS

After analysing the titles and summaries, 10 articles met the eligibility criteria.

DISCUSSION

According to the literature, most tests were made in moderate psoriasis with doses ranging from 0.25 to 2μg, demonstrating improvement with this treatment modality. Some studies suggest the use of high doses, but the biggest concern is hypercalciuria as a side effect.

CONCLUSION

The use of active metabolites of vitamin D orally for the treatment of psoriasis showed efficacy and safety.

Emerging topical treatments for psoriasis

INTRODUCTION

Psoriasis is an immune-mediated chronic inflammatory skin disease which classically presents as erythematous, scaly plaques affecting extensor surfaces of the limbs, scalp and trunk. Approximately 80% of patients have a mild-to-moderate form routinely treated with topical medications, whereas phototherapy, systemic and biological therapies are typically reserved for treatment of moderate-to-severe psoriasis.

AREAS COVERED

The major advances in psoriasis therapy in the past 15 years have been in new immunomodulatory and biological molecules, with a significant unmet need to have new, efficient and safe topical treatment options for the large percentage of patients for whom systemic therapy is not indicated. The available topical therapies (corticosteroids and vitamin D3 analogs) have remained relatively unchanged over the past several decades. This article reviews emerging topical drugs and formulations currently under evaluation in clinical trials.

EXPERT OPINION

The time is right for a revolution in our topical therapy armamentarium. It has lagged significantly behind the systemic biological evolution of new drug development. Our large psoriasis population with mild-to-moderate psoriasis certainly deserves potent but safe and innovative topical agents with a new mode of action as well as with long-lasting clinical efficacy.

Specific targeting of interleukin-23p19 as effective treatment for psoriasis

Interleukin (IL)-23 is a heterodimeric cytokine composed of a distinct p19 subunit and a p40 subunit, which it shares with IL-12. The dermatology and rheumatology communities have long surmised that anti-IL-12/23p40 antibodies suppress autoinflammatory disease owing to their effect on IL-12. The aim of this review is to bring to light new data from murine and human studies demonstrating that in fact IL-23 and its resulting Th17 pathway mediate the inflammatory cascade that induces psoriatic plaque formation. Evidence derives from lesional immunohistochemical analyses, genetic studies, and research in other autoimmune diseases. Although current IL-12/23p40 inhibitors have shown good efficacy and safety, data regarding the functional role of IL-12 in immune defense suggest that preserving this cytokine would be beneficial. To date, evidence from mouse models and preliminary data in human beings show that specifically targeting IL-23p19 may be a safer but equally efficacious treatment option.