Ustekinumab for the treatment of psoriasis and psoriatic arthritis: A drug evaluation and literature review.
Introduction: Psoriasis is an autoimmune, inflammatory disorder characterized by proliferation of keratinocytes, and it may be associated with a systemic inflammatory articular disorder, psoriatic arthritis. The presentations of psoriasis and psoriatic arthritis are heterogeneous, and our understanding of the underlying pathogenesis has led to a better understanding of the vital role of the IL-23/Th17 immune axis.
Areas covered: Ustekinumab is a monoclonal antibody against IL-12 and IL-23, and this review will focus on its role in the management of psoriatic disease. The pathogenesis of psoriasis and psoriatic arthritis is a multifactorial process involving genetic, environmental, and lifestyle factors. IL-23 signaling and activation of Th17 cells leads to a self-perpetuating inflammatory loop resulting in continuous keratinocyte proliferation and synovitis. Treatment options are varied, ranging from topical therapy to injection of targeted biologic DMARDs. Evidence on the use of ustekinumab in the management of psoriasis is strong, but it is not as impressive in management of psoriatic arthritis.
Expert Opinion: IL-12/23 inhibition appears to be a good first line option for plaque psoriasis, but efficacy in psoriatic arthritis does not compare favorably to IL-17 inhibition. In general, poorer responses to therapy with any biologic DMARD in psoriatic arthritis cohorts highlight psoriatic disease heterogeneity. Until new knowledge can remedy the failure of monotherapy, synergistic methods may have to be explored, including combination biologic therapy.