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Psoriasis Academy

Psoriasis Treatment

Read time: 210 mins
Last updated:26th May 2022

Learn about the inflammatory pathways involved in disease initiation and progression and the latest updates on treatments for moderate-to-severe psoriasis, including:

  • Psoriasis pathophysiology in our expert interview with Professor Stefano Piaserico
  • Key clinical trial results of available systemic and biologic treatments
  • Recent long-term efficacy and safety data with Professor Diamant Thaçi

Treatment goals for psoriasis

How important is maintenance of response to patients with psoriasis?


Psoriasis is a chronic systemic inflammatory condition, with long-term systemic maintenance therapy recognised as the preferred method of clinical management. Greater understanding of the inflammatory and immunological pathways involved in psoriasis has led to the development of many targeted psoriasis treatments1–8.

Many people with psoriasis express frustration and dissatisfaction with their treatment because of a failure to achieve their treatment goals and long-term control9

This is especially true for people with moderate-to-severe psoriasis who experience a high impact on quality of life, long absences from work, and require frequent inpatient care9. In cases of high disease activity, continual treatment is the preferred option over switching of therapies9. Data from long-term clinical studies could therefore be a valuable guide for determining treatment goals.

Clinically meaningful goals for psoriasis

Several factors should be taken into account when establishing treatment goals for systemic therapy in people with moderate-to-severe psoriasis, including disease severity, the coexistence of psoriatic arthritis (PsA) or other comorbidities, physical impact, psychological and social well-being, and the risk–benefit ratio of continuous systemic treatment1–8.

A person-centred approach to care requires therapeutic decisions to align with patients’ needs and goals for treatment. In people with moderate-to-severe psoriasis, the desired treatment goals can be wide-ranging and go beyond merely achieving skin clearance10.

An analysis of the German Psoriasis Registry (PsoBest), that aimed to establish important treatment goals for patients receiving systemic treatment, found that, in addition to symptom reduction, patients desired a normal everyday life and treatment that did not constitute an additional burden (N=3,066)10.

Greater clearance also translates to greater patient satisfaction; however, effective treatment of psoriasis may lead to a lower level of disease that can be tolerated11. As a consequence, discontinuation of treatment following an initial success can also lead to a worsening of quality of life11.

How important is maintenance of response to people with psoriasis?

Learn about the importance of maintaining treatment response for improving the social, environmental, and occupational quality of life of patients.

Even small recurrences of psoriasis can have a disproportionately large impact on quality of life in patients with psoriasis12. This may also be true of drug dose reduction following initial treatment success13.

This highlights the importance of avoiding unnecessary switching and recognising patient expectations for long-term control and improved quality of life in order to develop and reach achievable clinical goals. Failure to do so could also be a contributing factor to the lower adherence to treatment in psoriasis compared to other chronic conditions11.

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Inflammatory pathways in psoriasis

Psoriasis is more than a dermatological disorder. It is a chronic immune-mediated disease in which genetically susceptible individuals develop cutaneous inflammation and keratinocyte hyperproliferation13,14.

Psoriasis is associated with epidermal thickening and keratinocyte hyperproliferation. As a result, the skin becomes inflamed and has raised plaques with silvery scales, which can cover large areas of the body13,14,15.

Clinical course

The clinical course of psoriasis can be divided into two stages: an initiation phase and a maintenance phase that perpetuates the inflammatory state16. This separation may be helpful when considering treatments that act in the trigger phase and those that block the self-perpetuating cycle of inflammation17

The histological features of psoriasis include epidermal (keratinocyte) hyperplasia, leukocyte infiltrates and an increased number of leaky vessels in the dermis of the skin. Notably, lymphoid-like tissues have also been identified in the psoriatic plaques17.

Psoriasis pathophysiology

Figure 3. Psoriasis pathophysiology (Adapted from Palfreeman et al15).

Initiation phase

An interplay between environmental and genetic factors facilitates disease-initiating events and the initiation of the complex and dynamic psoriatic cascade within skin and immune cells13

Introduction to Psoriasis Pathophysiology – Professor Stefano Piaserico

Find out more about the basics of psoriasis pathophysiology in this brief, yet highly informative introductory video from Professor Stefano Piaserico.

The histological features of cutaneous psoriasis are due to the interactions between T cells, dendritic cells and keratinocytes, giving rise to sustained inflammation in the skin (Figure 4)17,18. It is now well accepted that T cells, particularly T helper (Th) 17 lymphocytes, play an important role as effector cells in the pathogenesis of psoriasis16,19.

Early events in psoriasis involve the following steps18:

  • Skin insults activate dendritic cells (DCs) through pattern recognition receptors (PRRs) or cytokines interleukin 1 (IL-1), TNFα and IL-36. Meanwhile, a subset of DCs called plasmacytoid dendritic cells (pDCs) that typically mount a type 1 interferon (IFN) response to viral/microbial DNA have also been implicated in psoriasis
    • Research has suggested that combination of self-DNA with an antimicrobial peptide called LL37 (also called CAMP) can lead to a pDC-mediated immune response against self-DNA and subsequent activation of T cells. Infiltration of psoriatic skin has been observed for pDCs and it has been hypothesised that skin damage and subsequent release of self-DNA can lead to local pDC activation and drive autoimmunity and inflammation in psoriasis20
  • Activated DCs produce IL-23, which activates T cells and innate lymphoid cells (ILCs) to produce TNFα, IL-17 and IL-22
    • IL-22 induces keratinocyte hyperproliferation
    • TNFα and IL-17 activate DCs and keratinocytes, leading to up-regulation of adhesion molecules by the skin epithelium, angiogenesis and chemokine production
    • IL-17–induced chemokines CXCL1 and CXCL8 which recruit neutrophils
  • IL-17R engagement by keratinocytes leads to production of CCL20, which attracts more circulating CCR6+ γδ T cells and ILCs. This escalates into a self-amplifying inflammatory loop that can also be mediated by the adaptive immune system18

Initiation of psoriasis

Figure 4. Initiation of psoriasis (Adapted from Becher et al18).
CCL20, chemokine ligand 20; CCR6, chemokine receptor 6; CLA, cutaneous lymphocyte antigen; CXCL, chemokine (C-X-C motif) ligand; IFN-γ, interferon-gamma; IL, interleukin; ILC, innate lymphoid cells; PRRs, pattern recognition receptors; RORγt, retinoid-related orphan receptor γt; TH, T helper cell; TNF-α, tumour necrosis factor-alpha.

Maintenance phase

Key processes during disease maintenance involve ‘cross talk’ between epithelial and immune cells and the transition from innate to adaptive immunity as described in Figure 513

Maintaining psoriasis – transition from adaptive to innate immunity

Figure 5. Maintaining psoriasis – transition from adaptive to innate immunity (Adapted from Nestle et al13).
CCL, chemokine ligand; CXCL, chemokine (C-X-C motif) ligand; IFN-α, interferon-alpha; IFN-γ, interferon-gamma; IL, interleukin; TH, T helper cell; TNF-α, tumour necrosis factor-alpha.

Targeting inflammatory pathways in psoriasis has been a common strategy; the cells and cytokines involved in the perpetuation/maintenance of psoriasis represent key therapeutic targets13,14,17,21-23:

  • Secretion of IL-23 and IL-12 by DCs within the lymph nodes induces naïve T cells to differentiate into Th17 or Th1 cells, respectively
  • T cells migrate to skin and produce further cytokines (IFNγ, IL-17 and IL-22) which drive epidermal cell proliferation

These cytokines lead to over-activity of keratinocytes and this leads to the release of cytokines and chemokines that continue to recruit and activate inflammatory cells. The balance between regulatory and effector functions is lost and regulatory T cells (Tregs) are unable to control ongoing inflammation.

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Systemic and biologic treatments for psoriasis

Professor Peter van de Kerkhof (Radboud University Nijmegen Medical Centre, Netherlands) discusses treatment options for localised psoriasis and highlights the importance of contraindications and risk factors when considering systemic treatments for psoriasis.

Are treatment options limited for patients with localised psoriasis?

What should you consider in managing patients with moderately severe psoriasis?

1

For people with milder disease, first-line psoriasis treatment often involves topical therapies including corticosteroids, vitamin D3 analogues, and combination products6. However, people with moderate-to-severe and refractory symptoms may be candidates for systemic therapy4,5,53.

In a survey conducted in the United States, Canada, France, Germany, Italy, Spain, and the United Kingdom, dermatologists reported that among people with moderate-to-severe psoriasis, approximately 75% of patients were receiving topical therapy, 20% of patients were receiving conventional oral therapy, and 20% of patients were receiving biologics54

Systemic treatments for psoriasis

Systemic treatments for psoriasis are usually reserved for people with moderate-to-severe forms of the disease (Psoriasis Area Severity Index [PASI] >10, or Body Surface Area [BSA] >10, and Dermatology Life Quality Index [DLQI] >10), or milder forms with a significant impact on quality of life that cannot be controlled by topical treatment2–5,55. Systemic treatments include oral drugs, subcutaneous injections, and intravenous infusions2,4,5,55.

Current treatment guidelines recommend a conventional oral drug as first-line systemic treatment for moderate-to-severe psoriasis, whereas a biologic is applied as second-line treatment in case of treatment failure, intolerance or contra-indication to an oral therapy4,5,55. Options for systemic therapy include immunosuppressive and immunomodulatory drugs such as methotrexate, ciclosporin, acitretin, fumaric acid esters, apremilast and biologic agents4,5,55.

While the trend is for biologics to be prescribed earlier, other systemic options, such as dimethyl fumarate and apremilast offer an alternative in the moderate-to-severe psoriasis population in the goal of achieving long-term control4,5,56,57.

A 2020 Delphi exercise to recategorise psoriasis severity has led to final international consensus stating that psoriasis patients should be classified as candidates for systemic therapy if they meet at least 1 of the following criteria58:

  1. BSA >10%
  2. Disease involving special areas
  3. Failure of topical therapy

Patient quality of life should also be considered in the decision to move to systemic treatment. Professor Peter van de Kerkhof (Department of Dermatology, Radboud University, the Netherlands) describes how even very limited disease can have a dramatic effect on a patient’s quality of life.

There are many current systemic treatments available that differ in terms efficacy and safety, and the two must be balanced when making therapeutic decisions. Treatment with systemics can provide long-term benefit for some patients with psoriasis. 

Professor Peter van de Kerkhof reminds us of the importance of considering contraindications and risk factors in selecting systemic treatments.

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Key research and clinical data

Psoriasis-related publications have grown substantially since 1960, and recent discoveries have paved the way for future research. Although research topics have expanded and diversified, the goal of research has remained to better understand psoriasis and its treatment to benefit people living with the disease176.

In this section, we provide a concise overview of the key results from the most significant clinical trials for each systemic and biologic treatment currently available.

Fumaric acid ester key clinical trials

Dimethyl fumarate

The European Medicines Agency's (EMAs) decision to approve a new formulation dimethyl fumarate (DMF) across Europe in 2017 was based on a Phase III, double-blind, placebo-controlled, non-inferiority trial (BRIDGE), which assessed the efficacy and safety of the new formulation DMF, compared with placebo, and an older DMF72

The BRIDGE study72

In the BRIDGE trial, patients were randomised to receive a new formulation DMF, an older formulation DMF, or placebo (2:2:1) for 16 weeks, up-titrating to a maximum daily DMF dose of 720 mg, depending upon individual response72.

At week 16: 

The BRIDGE study at Week 16

LAS410008, a new formulation DMF.

Most treatment‐related adverse events were classed as ‘mild’72.

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Achieving long-term control in moderate-to-severe psoriasis

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  1. Nograles KE, Davidovici B, Krueger JG. New Insights in the Immunologic Basis of Psoriasis. Semin Cutan Med Surg. 2010;29(1):3–9.
  2. Nast A, Boehncke WH, Mrowietz U, Ockenfels HM, Philipp S, Reich K, et al. S3 - Guidelines on the treatment of psoriasis vulgaris (English version). Update. JDDG - J Ger Soc Dermatology. 2012;10(SUPPL.2):S1-s95.
  3. Boehncke WH, Boehncke S. More than skin-deep: The many dimensions of the psoriatic disease. Swiss Medical Weekly. 2014;144. doi:10.4414/smw.2014.13968.
  4. Nast A, Smith C, Spuls PI, Avila Valle G, Bata-Csörgö Z, Boonen H, et al. EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris – Part 1: treatment and monitoring recommendations. J Eur Acad Dermatology Venereol. 2020;34(11):2461–2498.
  5. Nast A, Smith C, Spuls PI, Avila Valle G, Bata-Csörgö Z, Boonen H, et al. EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris – Part 2: specific clinical and comorbid situations. J Eur Acad Dermatology Venereol. 2021;35(2):281–317.
  6. Elmets CA, Korman NJ, Prater EF, Wong EB, Rupani RN, Kivelevitch D, et al. Joint AAD–NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol. 2021;84(2):432–470.
  7. Menter A, Strober BE, Kaplan DH, Kivelevitch D, Prater EF, Stoff B, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019;80(4):1029–1072.
  8. Menter A, Gelfand JM, Connor C, Armstrong AW, Cordoro KM, Davis DMR, et al. Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies. J Am Acad Dermatol. 2020;82(6):1445–1486.
  9. Reich K, Mrowietz U. Therapieziele bei der behandlung der psoriasis. JDDG - J Ger Soc Dermatology. 2007;5(7):566–574.
  10. Blome C, Gosau R, Radtke MA, Reich K, Rustenbach SJ, Spehr C, et al. Patient-relevant treatment goals in psoriasis. Arch Dermatol Res. 2016;308(2):69–78.
  11. Strober BE, van der Walt JM, Armstrong AW, Bourcier M, Carvalho AVE, Chouela E, et al. Clinical Goals and Barriers to Effective Psoriasis Care. Dermatol Ther (Heidelb). 2019;9(1):5–18.
  12. Papp K, Menter A, Poulin Y, Gu Y, Sasso EH. Long-term outcomes of interruption and retreatment vs. continuous therapy with adalimumab for psoriasis: Subanalysis of REVEAL and the open-label extension study. J Eur Acad Dermatology Venereol. 2013;27(5):634–642.
  13. Poulin Y, Sheth P, Gu Y. Psoriasis patients required to discontinue adalimumab therapy have worsening in their quality of life out of proportion to worsening in the objective signs of disease: Subanalysis of REVEAL. J Am Acad Dermatol. 2012;66(4):AB201.
  14. Okubo Y, Tsuruta D, Tang AC, Inoue S, Torisu-Itakura H, Hanada T, et al. Analysis of treatment goal alignment between Japanese psoriasis patients and their paired treating physicians. J Eur Acad Dermatology Venereol. 2018;32(4):606–614.
  15. Strober B, Papp KA, Lebwohl M, Reich K, Paul C, Blauvelt A, et al. Clinical meaningfulness of complete skin clearance in psoriasis. J Am Acad Dermatol. 2016;75(1):77-82.e7.
  16. Eghlileb AM, Davies EEG, Finlay AY. Psoriasis has a major secondary impact on the lives of family members and partners. Br J Dermatol. 2007;156(6):1245–1250.
  17. Armstrong A, Jarvis S, Boehncke WH, Rajagopalan M, Fernández-Peñas P, Romiti R, et al. Patient perceptions of clear/almost clear skin in moderate-to-severe plaque psoriasis: results of the Clear About Psoriasis worldwide survey. J Eur Acad Dermatology Venereol. 2018;32(12):2200–2207.
  18. Nestle FO, Kaplan DH, Barker J. Mechanisms of disease: Psoriasis. N Engl J Med. 2009;361(5):496–509.
  19. Boehncke WH, Schön MP. Psoriasis. Lancet. 2015;386(9997):983–994.
  20. Palfreeman AC, McNamee KE, McCann FE. New developments in the management of psoriasis and psoriatic arthritis: A focus on apremilast. Drug Des Devel Ther. 2013;7:201–210.
  21. Sabat R, Philipp S, Höflich C, Kreutzer S, Wallace E, Asadullah K, et al. Immunopathogenesis of psoriasis. Exp Dermatol. 2007;16(10):779–798.
  22. Diani M, Altomare G, Reali E. T cell responses in psoriasis and psoriatic arthritis. Autoimmunity Reviews. 2015;14(4):286–292.
  23. Becher B, Pantelyushin S. Interleukin-17-producing γδ T cells go under the skin? Nat Med. 2012;18(12):1748–1750.
  24. Büchau AS, Gallo RL. Innate immunity and antimicrobial defense systems in psoriasis. Clinics in Dermatology. 2007;25(6):616–624.
  25. Chandrakumar SF, Yeung J. Interleukin-17 antagonists in the treatment of psoriasis. J Cutan Med Surg. 2015;19(2):109–114.
  26. Sugiyama H, Gyulai R, Toichi E, Garaczi E, Shimada S, Stevens SR, et al. Dysfunctional Blood and Target Tissue CD4 + CD25 high Regulatory T Cells in Psoriasis: Mechanism Underlying Unrestrained Pathogenic Effector T Cell Proliferation . J Immunol. 2005;174(1):164–173.
  27. Goodman WA, Levine AD, Massari J V., Sugiyama H, McCormick TS, Cooper KD. IL-6 Signaling in Psoriasis Prevents Immune Suppression by Regulatory T Cells. J Immunol. 2009;183(5):3170–3176.
  28. Brotas AM, Cunha JMT, Lago EHJ, Machado CCN, Carneiro SC da S. Fator de necrose tumoral-alfa e a rede de citocinas na psoriase. An Bras Dermatol. 2012;87(5):673–683.
  29. Ferreira VL, Borba, HL, de F. Bonetti, AF, Leonart, LP, Pontarolo R. Cytokines and Interferons: Types and Functions. In: Autoantibodies and Cytokines. 2019. IntechOpen: 65–87.
  30. Baliwag J, Barnes DH, Johnston A. Cytokines in psoriasis. 2015. Academic Press.
  31. Lowes MA, Suárez-Fariñas M, Krueger JG. Immunology of psoriasis. Annu Rev Immunol. 2014;32:227–255.
  32. Brunner PM, Koszik F, Reininger B, Kalb ML, Bauer W, Stingl G. Infliximab induces downregulation of the IL-12/IL-23 axis in 6-sulfo-LacNac (slan)+ dendritic cells and macrophages. J Allergy Clin Immunol. 2013;132(5):1184–93.
  33. Amatya N, Garg A V., Gaffen SL. IL-17 Signaling: The Yin and the Yang. Trends Immunol. 2017;38(5):310–322.
  34. Roman M, Chiu MW. Spotlight on brodalumab in the treatment of moderate-to-severe plaque psoriasis: Design, development, and potential place in therapy. Drug Des Devel Ther. 2017;11:2065–2075.
  35. Soler DC, McCormick TS. The dark side of regulatory T cells in psoriasis. J Invest Dermatol. 2011;131(9):1785–1786.
  36. Lønnberg AS, Zachariae C, Skov L. Targeting of interleukin-17 in the treatment of psoriasis. Clin Cosmet Investig Dermatol. 2014;7:251–259.
  37. Reich K, Armstrong AW, Foley P, Song M, Wasfi Y, Randazzo B, et al. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the treatment of patients with moderate to severe psoriasis with randomized withdrawal and retreatment: Results from the phase III, double-blind, p. J Am Acad Dermatol. 2017;76(3):418–431.
  38. Galluzzo M, D’Adamio S, Massaro A, Piccolo A, Bianchi L, Talamonti M. Spotlight on brodalumab in the treatment of plaque psoriasis: The evidence to date. Clin Cosmet Investig Dermatol. 2019;12:311–321.
  39. Di Meglio P, Nestle FO. The role of IL-23 in the immunopathogenesis of psoriasis. F1000 Biol Rep. 2010;2(1):40.
  40. Girolomoni G, Strohal R, Puig L, Bachelez H, Barker J, Boehncke WH, et al. The role of IL-23 and the IL-23/TH17 immune axis in the pathogenesis and treatment of psoriasis. J Eur Acad Dermatology Venereol. 2017;31(10):1616–1626.
  41. Leonardi CL, Kimball AB, Papp KA, Yeilding N, Guzzo C, Wang Y, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1). Lancet. 2008;371(9625):1665–1674.
  42. Langley RG, Lebwohl M, Krueger GG, Szapary PO, Wasfi Y, Chan D, et al. Long-term efficacy and safety of ustekinumab, with and without dosing adjustment, in patients with moderate-to-severe psoriasis: Results from the PHOENIX 2 study through 5 years of follow-up. Br J Dermatol. 2015;172(5):1371–1383.
  43. Gordon KB, Duffin KC, Bissonnette R, Prinz JC, Wasfi Y, Li S, et al. A Phase 2 Trial of Guselkumab versus Adalimumab for Plaque Psoriasis. N Engl J Med. 2015;373(2):136–144.
  44. Blauvelt A, Papp KA, Griffiths CEM, Randazzo B, Wasfi Y, Shen YK, et al. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: Results from the phase III, double-blinded, placebo- and active comparator–. J Am Acad Dermatol. 2017;76(3):405–417.
  45. Reich K, Papp KA, Blauvelt A, Tyring SK, Sinclair R, Thaçi D, et al. Tildrakizumab versus placebo or etanercept for chronic plaque psoriasis (reSURFACE 1 and reSURFACE 2): results from two randomised controlled, phase 3 trials. Lancet. 2017;390(10091):276–288.
  46. Zwicky P, Ingelfinger F, de Melo BMS, Ruchti F, Schärli S, Puertas N, et al. IL-12 regulates type 3 immunity through interfollicular keratinocytes in psoriasiform inflammation. Sci Immunol. 2021;6(64). doi:10.1126/SCIIMMUNOL.ABG9012.
  47. Gómez-García F, Ruano J, Gay-Mimbrera J, Aguilar-Luque M, Sanz-Cabanillas JL, Hernández Romero JL, et al. A Scoping Review Protocol to Explore the Use of Interleukin-1-Targeting Drugs for the Treatment of Dermatological Diseases: Indications, Mechanism of Action, Efficacy, and Safety. Dermatol Ther (Heidelb). 2018;8(2):195–202.
  48. Cai Y, Xue F, Quan C, Qu M, Liu N, Zhang Y, et al. A Critical Role of the IL-1β–IL-1R Signaling Pathway in Skin Inflammation and Psoriasis Pathogenesis. J Invest Dermatol. 2019;139(1):146–156.
  49. Hao JQ. Targeting interleukin-22 in psoriasis. Inflammation. 2014;37(1):94–99.
  50. Chiricozzi A, Romanelli P, Volpe E, Borsellino G, Romanelli M. Scanning the immunopathogenesis of psoriasis. International Journal of Molecular Sciences. 2018;19(1):179.
  51. Wawrzycki B, Pietrzak A, Grywalska E, Krasowska D, Chodorowska G, Roliński J. Interleukin-22 and Its Correlation with Disease Activity in Plaque Psoriasis. Arch Immunol Ther Exp (Warsz). 2019;67(2):103–108.
  52. Steffen S, Abraham S, Herbig M, Schmidt F, Blau K, Meisterfeld S, et al. Toll-Like Receptor-Mediated Upregulation of CXCL16 in Psoriasis Orchestrates Neutrophil Activation. J Invest Dermatol. 2018;138(2):344–354.
  53. Kim WB, Jerome D, Yeung J. Diagnosis and management of psoriasis. Can Fam Physician. 2017;63(4):278.
  54. Feldman SR, Goffe B, Rice G, Mitchell M, Kaur M, Robertson D, et al. The challenge of managing psoriasis: Unmet medical needs and stakeholder perspectives. Am Heal Drug Benefits. 2016;9(9):504–512.
  55. Nast A, Gisondi P, Ormerod AD, Saiag P, Smith C, Spuls PI, et al. European S3-Guidelines on the systemic treatment of psoriasis vulgaris - Update 2015 - Short version - EDF in cooperation with EADV and IPC. J Eur Acad Dermatology Venereol. 2015;29(12):2277–2294.
  56. Pathirana D, Ormerod AD, Saiag P, Smith C, Spuls PI, Nast A, et al. European S3-guidelines on the systemic treatment of psoriasis vulgaris. J Eur Acad Dermatology Venereol. 2009;23(SUPPL. 2):1–70.
  57. Mrowietz U, Barker J, Boehncke WH, Iversen L, Kirby B, Naldi L, et al. Clinical use of dimethyl fumarate in moderate-to-severe plaque-type psoriasis: a European expert consensus. J Eur Acad Dermatology Venereol. 2018;32:3–14.
  58. Strober B, Ryan C, van de Kerkhof P, van der Walt J, Kimball AB, Barker J, et al. Recategorization of psoriasis severity: Delphi consensus from the International Psoriasis Council. J Am Acad Dermatol. 2020;82(1):117–122.
  59. Electronic Medicines Compendium. Capimune. Summary of Product Characteristics. 2021. https://www.medicines.org.uk/emc/product/695/smpc. Accessed 4 January 2022.
  60. Belge K, Brück J, Ghoreschi K. Advances in treating psoriasis. F1000Prime Reports. 2014;6:4.
  61. Gyulai R, Bagot M, Griffiths CEM, Luger T, Naldi L, Paul C, et al. Current practice of methotrexate use for psoriasis: Results of a worldwide survey among dermatologists. J Eur Acad Dermatology Venereol. 2015;29(2):224–231.
  62. Electronic Medicines Compendium. Methofill. Summary of product characteristics. 2021. https://www.medicines.org.uk/emc/product/9057/smpc. Accessed 17 February 2021.
  63. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies. J Am Acad Dermatol. 2009;60(4):643–659.
  64. Rivera R, Vilarrasa E, Ribera M, Roe E, Kueder-Pajares T, Zayas AI, et al. Unmet needs in patients with moderate-to-severe plaque psoriasis treated with methotrexate in real world practice: FirST study. J Dermatolog Treat. 2020. doi:10.1080/09546634.2020.1801977.
  65. Dommasch ED, Kim SC, Lee MP, Gagne JJ. Risk of Serious Infection in Patients Receiving Systemic Medications for the Treatment of Psoriasis. JAMA Dermatology. 2019;155(10):1142–1152.
  66. Litjens NHR, Rademaker M, Ravensbergen B, Rea D, van der Plas MJA, Thio B, et al. Monomethylfumarate affects polarization of monocyte-derived dendritic cells resulting in down-regulated Th1 lymphocyte responses. Eur J Immunol. 2004;34(2):565–575.
  67. Naldi L, Griffiths CEM. Traditional therapies in the management of moderate to severe chronic plaque psoriasis: An assessment of the benefits and risks. Br J Dermatol. 2005;152(4):597–615.
  68. Bovenschen HJ, Langewouters AMG, Van De Kerkhof PCM. Dimethylfumarate for psoriasis: Pronounced effects on lesional T-cell subsets, epidermal proliferation and differentiation, but not on natural killer T cells in immunohistochemical study. Am J Clin Dermatol. 2010;11(5):343–350.
  69. Ghoreschi K, Brück J, Kellerer C, Deng C, Peng H, Rothfuss O, et al. Fumarates improve psoriasis and multiple sclerosis by inducing type II dendritic cells. J Exp Med. 2011;208(11):2291–2303.
  70. Reich K, Mrowietz U, Radtke MA, Thaci D, Rustenbach SJ, Spehr C, et al. Drug safety of systemic treatments for psoriasis: results from The German Psoriasis Registry PsoBest. Arch Dermatol Res. 2015;307(10):875–883.
  71. Reszke R, Szepietowski JC. A safety evaluation of dimethyl fumarate in moderate-to-severe psoriasis. Expert Opin Drug Saf. 2020;19(4):373–380.
  72. Mrowietz U, Szepietowski JC, Loewe R, van de Kerkhof P, Lamarca R, Ocker WG, et al. Efficacy and safety of LAS41008 (dimethyl fumarate) in adults with moderate-to-severe chronic plaque psoriasis: a randomized, double-blind, Fumaderm®- and placebo-controlled trial (BRIDGE). Br J Dermatol. 2017;176(3):615–623.
  73. Chiricozzi A, Panduri S, Dini V, Tonini A, Gualtieri B, Romanelli M. Optimizing acitretin use in patients with plaque psoriasis. Dermatol Ther. 2017;30(2):e12453.
  74. Ortiz NEG, Nijhawan RI, Weinberg JM. Acitretin. Dermatol Ther. 2013;26(5):390–399.
  75. Dogra S, Yadav S. Acitretin in psoriasis: An evolving scenario. Int J Dermatol. 2014;53(5):525–538.
  76. European Medicines Agency. Apremilast. Summary of Opinion. 2014. http://www.ema.europa.eu/docs/en_GB/document_library/Summary_of_opinion_-_Initial_authorisation/human/003746/WC500177621.pdf. Accessed 17 February 2021.
  77. European Medicines Agency. Otezla. Summary of Product Characteristics. 2021. https://www.ema.europa.eu/en/documents/product-information/otezla-epar-product-information_en.pdf. Accessed 17 February 2021.
  78. Abuhilal M, Walsh S, Shear N. Use of apremilast in combination with other therapies for treatment of chronic plaque psoriasis: A retrospective study. J Cutan Med Surg. 2016;20(4):313–316.
  79. Papp K, Reich K, Leonardi CL, Kircik L, Chimenti S, Langley RGB, et al. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, in patients with moderate to severe plaque psoriasis: Results of a phase III, randomized, controlled trial (Efficacy and Safety Trial Evaluating the Effects of Apremilast in Psoriasis [ESTEEM] 1). J Am Acad Dermatol. 2015;73(1):37–49.
  80. Paul C, Cather J, Gooderham M, Poulin Y, Mrowietz U, Ferrandiz C, et al. Efficacy and safety of apremilast, an oral phosphodiesterase 4 inhibitor, in patients with moderate-to-severe plaque psoriasis over 52 weeks: A phase III, randomized controlled trial (ESTEEM 2). Br J Dermatol. 2015;173(6):1387–1399.
  81. Bissonnette R, Pariser DM, Wasel NR, Goncalves J, Day RM, Chen R, et al. Apremilast, an oral phosphodiesterase-4 inhibitor, in the treatment of palmoplantar psoriasis: Results of a pooled analysis from phase II PSOR-005 and phase III Efficacy and Safety Trial Evaluating the Effects of Apremilast in Psoriasis (ESTEEM) clinical . J Am Acad Dermatol. 2016;75(1):99–105.
  82. Rich P, Gooderham M, Bachelez H, Goncalves J, Day RM, Chen R, et al. Apremilast, an oral phosphodiesterase 4 inhibitor, in patients with difficult-to-treat nail and scalp psoriasis: Results of 2 phase III randomized, controlled trials (ESTEEM 1 and ESTEEM 2). J Am Acad Dermatol. 2016;74(1):134–142.
  83. Thaçi D, Kimball A, Foley P, Poulin Y, Levi E, Chen R, et al. Apremilast, an oral phosphodiesterase 4 inhibitor, improves patient-reported outcomes in the treatment of moderate to severe psoriasis: results of two phase III randomized, controlled trials. J Eur Acad Dermatology Venereol. 2017;31(3):498–506.
  84. Armstrong AW, Betts KA, Sundaram M, Thomason D, Signorovitch JE. Comparative efficacy and incremental cost per responder of methotrexate versus apremilast for methotrexate-naïve patients with psoriasis. J Am Acad Dermatol. 2016;75(4):740–746.
  85. Crowley J, Thaçi D, Joly P, Peris K, Papp KA, Goncalves J, et al. Long-term safety and tolerability of apremilast in patients with psoriasis: Pooled safety analysis for ≥156 weeks from 2 phase 3, randomized, controlled trials (ESTEEM 1 and 2). J Am Acad Dermatol. 2017;77(2):310-317.e1.
  86. Cline A, Hill D, Lewallen R, Feldman SR. Current status and future prospects for biologic treatments of psoriasis. Expert Rev Clin Immunol. 2016;12(12):1273–1287.
  87. Gisondi P, Del Giglio M, Girolomoni G. Treatment approaches tomoderate to severe psoriasis. Int J Mol Sci. 2017;18(11):2427.
  88. Menter A, Tyring SK, Gordon K, Kimball AB, Leonardi CL, Langley RG, et al. Adalimumab therapy for moderate to severe psoriasis: A randomized, controlled phase III trial. J Am Acad Dermatol. 2008;58(1):106–115.
  89. Hawkes JE, Chan TC, Krueger JG. Psoriasis pathogenesis and the development of novel targeted immune therapies. J Allergy Clin Immunol. 2017;140(3):645–653.
  90. Kim J, Krueger JG. Highly Effective New Treatments for Psoriasis Target the IL-23/Type 17 T Cell Autoimmune Axis. Annu Rev Med. 2017;68:255–269.
  91. Chan TC, Hawkes JE, Krueger JG. Interleukin 23 in the skin: role in psoriasis pathogenesis and selective interleukin 23 blockade as treatment. Ther Adv Chronic Dis. 2018;9(5):111–119.
  92. European Medicines Compendium. Tremfya. Summary of Product Characteristics. 2021. https://www.medicines.org.uk/emc/product/9587. Accessed 19 February 2021.
  93. European Medicines Compendium. Ozurdex. Summary of Prescribing Information. 2021. https://www.medicines.org.uk/emc/product/5654/smpc#gref. Accessed 17 February 2021.
  94. Sun Pharma. Sun Pharma announces receipt of European Commission approval for ILUMETRI® (tildrakizumab) by Almirall for treatment of moderate-to-severe chronic plaque psoriasis. 2018. www.sunpharma.com/Media/Press-Releases/Press Release European Commission Approval For ILUMETRI.pdf. Accessed 17 February 2021.
  95. European Medicines Compendium. Flixabi. Summary of Product Characteristics. 2021. https://www.medicines.org.uk/emc/product/7265/smpc. Accessed 5 January 2022.
  96. Yamauchi PS, Bagel J. Next-generation biologics in the management of plaque psoriasis: A literature review of IL-17 inhibition. J Drugs Dermatology. 2015;14(3):244–250.
  97. Subedi S, Gong Y, Chen Y, Shi Y. Infliximab and biosimilar infliximab in psoriasis: Efficacy, loss of efficacy, and adverse events. Drug Des Devel Ther. 2019;13:2491–2502.
  98. Reich K, Wozel G, Zheng H, Van Hoogstraten HJF, Flint L, Barker J. Efficacy and safety of infliximab as continuous or intermittent therapy in patients with moderate-to-severe plaque psoriasis: Results of a randomized, long-term extension trial (RESTORE2). Br J Dermatol. 2013;168(6):1325–1334.
  99. Shear NH, Hartmann M, Toledo-Bahena M, Katsambas A, Connors L, Chang Q, et al. Long-term efficacy and safety of infliximab maintenance therapy in patients with plaque-type psoriasis in real-world practice. Br J Dermatol. 2014;171(3):631–641.
  100. Kim WB, Marinas JEC, Qiang J, Shahbaz A, Greaves S, Yeung J. Adverse events resulting in withdrawal of biologic therapy for psoriasis in real-world clinical practice: A Canadian multicenter retrospective study. J Am Acad Dermatol. 2015;73(2):237–241.
  101. Puig L, Carretero G, Daudén E, Ferrándiz C, Marrón SE, Martorell A, et al. Biosimilars in Dermatology: Current Situation (Part I). Actas Dermo-Sifiliográficas (English Ed. 2015;106(7):545–549.
  102. Gisondi P, Geat D, Pizzolato M, Girolomoni G. State of the art and pharmacological pipeline of biologics for chronic plaque psoriasis. Curr Opin Pharmacol. 2019;46:90–99.
  103. Jha A, Upton A, Dunlop WCN, Akehurst R. The Budget Impact of Biosimilar Infliximab (Remsima®) for the Treatment of Autoimmune Diseases in Five European Countries. Adv Ther. 2015;32(8):742–756.
  104. Kivelevitch D, Mansouri B, Menter A. Long term efficacy and safety of etanercept in the treatment of psoriasis and psoriatic arthritis. Biol Targets Ther. 2014;8:169–182.
  105. Electronic Medicines Compendium. Buprenorphine. Summary of Product Characteristics. 2021. https://www.medicines.org.uk/emc/medicine/26614. Accessed 17 February 2021.
  106. Papp KA, Yang M, Sundaram M, Jarvis J, Betts KA, Bao Y, et al. Comparison of Adalimumab and Etanercept for the Treatment of Moderate to Severe Psoriasis: An Indirect Comparison Using Individual Patient Data from Randomized Trials. Value Heal. 2018;21(1):1–8.
  107. Lee JY, Kang S, Park JS, Jo SJ. Prevalence of psoriasis in Korea: A population-based epidemiological study using the Korean national health insurance database. Ann Dermatol. 2017;29(6):761–767.
  108. Luger T, Schopf RE, Schwanke A, Langhammer S, Meng T, Löschmann PA. An observational study to evaluate the long-term outcomes of treatment with etanercept in patients with plaque-type psoriasis. J Eur Acad Dermatology Venereol. 2016;30(10):1730–1741.
  109. Leonardi CL, Powers JL, Matheson RT, Goffe BS, Zitnik R, Wang A, et al. Etanercept as Monotherapy in Patients with Psoriasis. N Engl J Med. 2003;349(21):2014–2022.
  110. Papp KA. The long-term efficacy and safety of new biological therapies for psoriasis. Arch Dermatol Res. 2006;298(1):7–15.
  111. Kimball AB, Rothman KJ, Kricorian G, Pariser D, Yamauchi PS, Menter A, et al. OBSERVE-5: Observational postmarketing safety surveillance registry of etanercept for the treatment of psoriasis final 5-year results. J Am Acad Dermatol. 2015;72(1):115–122.
  112. Papp KA, Armstrong AW, Reich K, Karunaratne M, Valdecantos W. Adalimumab Efficacy in Patients with Psoriasis Who Received or Did Not Respond to Prior Systemic Therapy: A Pooled Post Hoc Analysis of Results from Three Double-Blind, Placebo-Controlled Clinical Trials. Am J Clin Dermatol. 2016;17(1):79–86.
  113. Menter A, Thaçi D, Wu JJ, Abramovits W, Kerdel F, Arikan D, et al. Long-Term Safety and Effectiveness of Adalimumab for Moderate to Severe Psoriasis: Results from 7-Year Interim Analysis of the ESPRIT Registry. Dermatol Ther (Heidelb). 2017;7(3):365–381.
  114. Wu JJ, Abramovits W, Valdecantos WC, Servin OR, Bereswill M, Arikan D, et al. 14030 Ten-year interim results from the ESPRIT registry: Real-world safety, effectiveness, and patient-reported outcomes of adalimumab for moderate to severe psoriasis. J Am Acad Dermatol. 2020;83(6):AB17.
  115. Derbyshire M. Patent expiry dates for biologicals: 2016 update. Generics Biosimilars Initiat J. 2017;6(1):27–30.
  116. ClinicalTrials.gov. NCT02326272 - A Study to Evaluate the Efficacy and Safety of Two Dose Levels of Certolizumab Pegol (CZP) in Subjects With Plaque Psoriasis (PSO). 2018. https://clinicaltrials.gov/ct2/show/NCT02326272. Accessed 24 February 2021.
  117. Cochrane Central Register of Controlled Trials (CENTRAL). Efficacy and Safety Study of Sirukumab in Subjects With Polymyalgia Rheumatica. 2016 https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01520779/full. Accessed 24 February 2021.
  118. Rutkowski D, Chinoy H, Warren RB. The Potential Benefits of Certolizumab Pegol in Patients with Concurrent Psoriatic Arthritis and Chronic Plaque Psoriasis: A Case Series and Review of the Literature. Dermatol Ther (Heidelb). 2019;9(2):373–381.
  119. Gottlieb AB, Blauvelt A, Thaçi D, Leonardi CL, Poulin Y, Drew J, et al. Certolizumab pegol for the treatment of chronic plaque psoriasis: Results through 48 weeks from 2 phase 3, multicenter, randomized, double-blinded, placebo-controlled studies (CIMPASI-1 and CIMPASI-2). J Am Acad Dermatol. 2018;79(2):302-314.e6.
  120. Lebwohl M, Blauvelt A, Paul C, Sofen H, Węgłowska J, Piguet V, et al. Certolizumab pegol for the treatment of chronic plaque psoriasis: Results through 48 weeks of a phase 3, multicenter, randomized, double-blind, etanercept- and placebo-controlled study (CIMPACT). J Am Acad Dermatol. 2018;79(2):266-276.e5.
  121. Curtis JR, Mariette X, Gaujoux-Viala C, Blauvelt A, Kvien TK, Sandborn WJ, et al. Long-term safety of certolizumab pegol in rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis, psoriasis and Crohn’s disease: A pooled analysis of 11 317 patients across clinical trials. RMD Open. 2019;5(1). doi:10.1136/rmdopen-2019-000942.
  122. Blauvelt A, Paul C, van de Kerkhof P, Warren RB, Gottlieb AB, Langley RG, et al. Long-term safety of certolizumab pegol in plaque psoriasis: pooled analysis over 3 years from three phase III, randomized, placebo-controlled studies. Br J Dermatol. 2021;184(4):640–651.
  123. Mariette X, Förger F, Abraham B, Flynn AD, Moltó A, Flipo RM, et al. Lack of placental transfer of certolizumab pegol during pregnancy: Results from CRIB, a prospective, postmarketing, pharmacokinetic study. Ann Rheum Dis. 2018;77(2):228–233.
  124. Clowse ME, Förger F, Hwang C, Thorp J, Dolhain RJ, Van Tubergen A, et al. Minimal to no transfer of certolizumab pegol into breast milk: Results from CRADLE, a prospective, postmarketing, multicentre, pharmacokinetic study. Ann Rheum Dis. 2017;76(11):1890–1896.
  125. Landells I, Marano C, Hsu MC, Li S, Zhu Y, Eichenfield LF, et al. Ustekinumab in adolescent patients age 12 to 17 years with moderate-to-severe plaque psoriasis: Results of the randomized phase 3 CADMUS study. J Am Acad Dermatol. 2015;73(4):594–603.
  126. Papp K, Gottlieb AB, Naldi L, Pariser D, Ho V, Goyal K, et al. Safety surveillance for ustekinumab and other psoriasis treatments from the psoriasis longitudinal assessment and (PSOLAR). J Drugs Dermatology. 2015;14(7):706–714.
  127. Strober BE, Bissonnette R, Fiorentino D, Kimball AB, Naldi L, Shear NH, et al. Comparative effectiveness of biologic agents for the treatment of psoriasis in a real-world setting: Results from a large, prospective, observational study (Psoriasis Longitudinal Assessment and Registry [PSOLAR]). J Am Acad Dermatol. 2016;74(5):851-861.e4.
  128. Menter A, Papp KA, Gooderham M, Pariser DM, Augustin M, Kerdel FA, et al. Drug survival of biologic therapy in a large, disease-based registry of patients with psoriasis: results from the Psoriasis Longitudinal Assessment and Registry (PSOLAR). J Eur Acad Dermatology Venereol. 2016;30(7):1148–1158.
  129. Egeberg A, Rosenø NAL, Aagaard D, Lørup EH, Nielsen ML, Nymand L, et al. Drug survival of biologics and novel immunomodulators for rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis, and psoriasis - A nationwide cohort study from the DANBIO and DERMBIO registries. Semin Arthritis Rheum. 2022;53:151979.
  130. Augustin M, Abeysinghe S, Mallya U, Qureshi A, Roskell N, McBride D, et al. Secukinumab treatment of plaque psoriasis shows early improvement in DLQI response - Results of a phase II regimen-finding trial. J Eur Acad Dermatology Venereol. 2016;30(4):645–649.
  131. Zweegers J, Groenewoud JMM, van den Reek JMPA, Otero ME, van de Kerkhof PCM, Driessen RJB, et al. Comparison of the 1- and 5-year effectiveness of adalimumab, etanercept and ustekinumab in patients with psoriasis in daily clinical practice: results from the prospective BioCAPTURE registry. Br J Dermatol. 2017;176(4):1001–1009.
  132. Bagel J, Blauvelt A, Nia J, Hashim P, Patekar M, de Vera A, et al. Secukinumab maintains superiority over ustekinumab in clearing skin and improving quality of life in patients with moderate to severe plaque psoriasis: 52-week results from a double-blind phase 3b trial (CLARITY). J Eur Acad Dermatology Venereol. 2021;35(1):135–142.
  133. Reich K, Papp KA, Blauvelt A, Langley RG, Armstrong A, Warren RB, et al. Bimekizumab versus ustekinumab for the treatment of moderate to severe plaque psoriasis (BE VIVID): efficacy and safety from a 52-week, multicentre, double-blind, active comparator and placebo controlled phase 3 trial. Lancet (London, England). 2021;397(10273):487–498.
  134. Johnson J&. Janssen press release: New two-year TremfyaTM (guselkumab) data show patients with moderate to severe plaque psoriasis achieved consistent rates of skin clearance. 2017. https://www.jnj.com/media-center/press-releases/new-two-year-tremfya-guselkumab-data-show-patients-with-moderate-to-severe-plaque-psoriasis-achieved-consistent-rates-of-skin-clearance. Accessed 17 February 2021.
  135. Electronic Medicines Compendium. Tremfya. Summary of Product Characteristics. 2021. https://www.medicines.org.uk/emc/product/9587. Accessed 17 February 2021.
  136. Nogueira M, Torres T. Guselkumab for the treatment of psoriasis – evidence to date. Drugs Context. 2019;8:212594.
  137. Pithadia DJ, Reynolds KA, Lee EB, Liao W, Wu JJ. Tildrakizumab in the treatment of psoriasis: latest evidence and place in therapy. Ther Adv Chronic Dis. 2019;10. doi:10.1177/2040622319865658.
  138. Electronic Medicines Compendium. Tildrakizumab. Summary of Product Characteristics. 2021. https://www.medicines.org.uk/emc/product/9819#gref. Accessed 10 December 2021.
  139. Reich K, Warren RB, Iversen L, Puig L, Pau-Charles I, Igarashi A, et al. Long-term efficacy and safety of tildrakizumab for moderate-to-severe psoriasis: pooled analyses of two randomized phase III clinical trials (reSURFACE 1 and reSURFACE 2) through 148 weeks. Br J Dermatol. 2020;182(3):605–617.
  140. Thaci D, Piaserico S, Warren RB, Gupta AK, Cantrell W, Draelos Z, et al. Five-year efficacy and safety of tildrakizumab in patients with moderate-to-severe psoriasis who respond at week 28: pooled analyses of two randomized phase III clinical trials (reSURFACE 1 and reSURFACE 2)*. Br J Dermatol. 2021;185(2):323–334.
  141. Drerup KA, Seemann C, Gerdes S, Mrowietz U. Effective and Safe Treatment of Psoriatic Disease with the Anti-IL-23p19 Biologic Tildrakizumab: Results of a Real-World Prospective Cohort Study in Nonselected Patients. Dermatology. 2021. doi:10.1159/000519924.
  142. Banaszczyk K. Risankizumab in the treatment of psoriasis - Literature review. Reumatologia. 2019;57(3):158–162.
  143. Machado Á, Torres T. Spotlight on risankizumab and its potential in the treatment of plaque psoriasis: evidence to date. Psoriasis Targets Ther. 2018;Volume 8:83–92.
  144. Strober B, Menter A, Leonardi C, Gordon K, Lambert J, Puig L, et al. Efficacy of risankizumab in patients with moderate-to-severe plaque psoriasis by baseline demographics, disease characteristics and prior biologic therapy: an integrated analysis of the phase III UltIMMa-1 and UltIMMa-2 studies. J Eur Acad Dermatology Venereol. 2020;34(12):2830–2838.
  145. Papp KA, Lebwohl MG, Puig L, Ohtsuki M, Beissert S, Zeng J, et al. Long-term efficacy and safety of risankizumab for the treatment of moderate-to-severe plaque psoriasis: interim analysis of the LIMMitless open-label extension trial beyond 3 years of follow-up. Br J Dermatol. 2021;185(6):1135–1145.
  146. Gordon KB, Strober B, Lebwohl M, Augustin M, Blauvelt A, Poulin Y, et al. Efficacy and safety of risankizumab in moderate-to-severe plaque psoriasis (UltIMMa-1 and UltIMMa-2): results from two double-blind, randomised, placebo-controlled and ustekinumab-controlled phase 3 trials. Lancet. 2018;392(10148):650–661.
  147. Bissonnette R, Luger T, Thaçi D, Toth D, Lacombe A, Xia S, et al. Secukinumab demonstrates high sustained efficacy and a favourable safety profile in patients with moderate-to-severe psoriasis through 5 years of treatment (SCULPTURE Extension Study). J Eur Acad Dermatology Venereol. 2018;32(9):1507–1514.
  148. Feldman SR, Gomez B, Meng X, Germino R. Secukinumab rapidly improves EQ-5D health status in patients with psoriasis: Pooled analysis from four phase 3 trials. J Dermatolog Treat. 2021;32(7):709–715.
  149. Blauvelt A, Reich K, Tsai TF, Tyring S, Vanaclocha F, Kingo K, et al. Secukinumab is superior to ustekinumab in clearing skin of subjects with moderate-to-severe plaque psoriasis up to 1 year: Results from the CLEAR study. J Am Acad Dermatol. 2017;76(1):60-69.e9.
  150. Magnolo N, Kingo K, Laquer V, Browning J, Reich A, Szepietowski JC, et al. A phase 3 open-label, randomized multicenter study to evaluate efficacy and safety of secukinumab in pediatric patients with moderate to severe plaque psoriasis: 24-week results. J Am Acad Dermatol. 2022;86(1):122–130.
  151. Van De Kerkhof PCM, Griffiths CEM, Reich K, Leonardi CL, Blauvelt A, Tsai TF, et al. Secukinumab long-term safety experience: A pooled analysis of 10 phase II and III clinical studies in patients with moderate to severe plaque psoriasis. J Am Acad Dermatol. 2016;75(1):83-98.e4.
  152. Electronic Medicines Compendium. Taltz. Summary of Product Characteristics. 2021. https://www.medicines.org.uk/emc/product/7233/smpc. Accessed 13 January 2021.
  153. Khattri S, Goldblum O, Solotkin K, Amir Y, Min MS, Ridenour T, et al. Early onset of clinical improvement with Ixekizumab in a Randomized, open-label study of patients with moderate-to-severe plaque psoriasis. J Clin Aesthet Dermatol. 2018;11(5):33–37.
  154. Sekhon S, Jeon C, Nakamura M, Yan D, Afifi L, Bhutani T, et al. Clinical utility of ixekizumab in the treatment of moderate-to-severe plaque psoriasis. Psoriasis Targets Ther. 2017;7:65–72.
  155. Strober B, Sigurgeirsson B, Popp G, Sinclair R, Krell J, Stonkus S, et al. Secukinumab improves patient-reported psoriasis symptoms of itching, pain, and scaling: Results of two phase 3, randomized, placebo-controlled clinical trials. Int J Dermatol. 2016;55(4):401–407.
  156. Langley RG, Kimball AB, Nak H, Xu W, Pangallo B, Osuntokun OO, et al. Long-term safety profile of ixekizumab in patients with moderate-to-severe plaque psoriasis: an integrated analysis from 11 clinical trials. J Eur Acad Dermatology Venereol. 2019;33(2):333–339.
  157. Foulkes AC, Warren RB. Brodalumab in psoriasis: Evidence to date and clinical potential. Drugs Context. 2019;8. doi:10.7573/dic.212570.
  158. Pinter A, Bonnekoh B, Hadshiew IM, Zimmer S. Brodalumab for the treatment of moderate-tosevere psoriasis: Case series and literature review. Clin Cosmet Investig Dermatol. 2019;12:509–517.
  159. Puig L, Lebwohl M, Bachelez H, Sobell J, Jacobson AA. Long-term efficacy and safety of brodalumab in the treatment of psoriasis: 120-week results from the randomized, double-blind, placebo- and active comparator–controlled phase 3 AMAGINE-2 trial. J Am Acad Dermatol. 2020;82(2):352–359.
  160. Steeland S, Vandenbroucke RE, Libert C. Nanobodies as therapeutics: Big opportunities for small antibodies. Drug Discov Today. 2016;21(7):1076–1113.
  161. Samtsov AV, Khairutdinov VR, Bakulev AL, Kubanov AA, Karamova AE, Artem’eva AV, et al. Efficacy and Safety of BCD-085, a Novel Interleukin-17 Inhibitor. Results of Phase II Clinical Trial in Patients with Moderate-to-Severe Plaque Psoriasis. Vestn Dermatol Venerol. 2017;112(5):52–63.
  162. Papp KA, Merola JF, Gottlieb AB, Griffiths CEM, Cross N, Peterson L, et al. Dual neutralization of both interleukin 17A and interleukin 17F with bimekizumab in patients with psoriasis: Results from BE ABLE 1, a 12-week randomized, double-blinded, placebo-controlled phase 2b trial. J Am Acad Dermatol. 2018;79(2):277-286.e10.
  163. Papp KA, Gooderham M, Jenkins R, Vender R, Szepietowski JC, Wagner T, et al. Granulocyte–macrophage colony-stimulating factor (GM-CSF) as a therapeutic target in psoriasis: randomized, controlled investigation using namilumab, a specific human anti-GM-CSF monoclonal antibody. Br J Dermatol. 2019;180(6):1352–1360.
  164. ClinicalTrials.gov. A study of JNJ-77242113 in participants with moderate-to-severe plaque psoriasis. 2022. https://clinicaltrials.gov/ct2/show/record/NCT05223868. Accessed 18 March 2022.
  165. Fridman JS, Scherle PA, Collins R, Burn TC, Li Y, Li J, et al. Selective Inhibition of JAK1 and JAK2 Is Efficacious in Rodent Models of Arthritis: Preclinical Characterization of INCB028050. J Immunol. 2010;184(9):5298–5307.
  166. Ghoreschi K, Jesson MI, Li X, Lee JL, Ghosh S, Alsup JW, et al. Modulation of Innate and Adaptive Immune Responses by Tofacitinib (CP-690,550). J Immunol. 2011;186(7):4234–4243.
  167. Papp KA, Menter MA, Abe M, Elewski B, Feldman SR, Gottlieb AB, et al. Tofacitinib, an oral Janus kinase inhibitor, for the treatment of chronic plaque psoriasis: Results from two randomized, placebo-controlled, phase III trials. Br J Dermatol. 2015;173(4):949–961.
  168. Feldman SR, Thaçi D, Gooderham M, Augustin M, de la Cruz C, Mallbris L, et al. Tofacitinib improves pruritus and health-related quality of life up to 52 weeks: Results from 2 randomized phase III trials in patients with moderate to severe plaque psoriasis. J Am Acad Dermatol. 2016;75(6):1162-1170.e3.
  169. Tian F, Chen Z, Xu T. Efficacy and safety of tofacitinib for the treatment of chronic plaque psoriasis: a systematic review and meta-analysis. J Int Med Res. 2019;47(6):2342–2350.
  170. Papp K, Gordon K, Thaçi D, Morita A, Gooderham M, Foley P, et al. Phase 2 Trial of Selective Tyrosine Kinase 2 Inhibition in Psoriasis. N Engl J Med. 2018;379(14):1313–1321.
  171. Valenzuela F, Paul C, Mallbris L, Tan H, Papacharalambous J, Valdez H, et al. Tofacitinib versus etanercept or placebo in patients with moderate to severe chronic plaque psoriasis: patient-reported outcomes from a Phase 3 study. J Eur Acad Dermatology Venereol. 2016;30(10):1753–1759.
  172. Federal Drug Administration. SMOFlipid Highlights of Prescribing Information. 2016 https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/207648lbl.pdf. Accessed 18 February 2021.
  173. Menter A, Cordoro KM, Davis DMR, Kroshinsky D, Paller AS, Armstrong AW, et al. Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients. J Am Acad Dermatol. 2020;82(1):161–201.
  174. Shi T, McAllister DA, O’Brien KL, Simoes EAF, Madhi SA, Gessner BD, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet. 2017;390(10098):946–58.
  175. Foundation NP. Primary Care & Psoriatic Disease. National Psoriasis Foundation. 2016. https://www.psoriasis.org/primary-care-and-psoriatic-disease/. Accessed 18 February 2021.
  176. Sako E, Famenini S, Wu JJ. Trends in Type of Original Psoriasis Publications by Decade, 1960 to 2010. Perm J. 2016;20(4). doi:10.7812/TPP/15-060.
  177. Reich K, Gooderham M, Green L, Bewley A, Zhang Z, Khanskaya I, et al. The efficacy and safety of apremilast, etanercept and placebo in patients with moderate-to-severe plaque psoriasis: 52-week results from a phase IIIb, randomized, placebo-controlled trial (LIBERATE). J Eur Acad Dermatology Venereol. 2017;31(3):507–517.
  178. Strober B, Bagel J, Lebwohl M, Gold LS, Jackson JM, Chen R, et al. Efficacy and safety of apremilast in patients with moderate plaque psoriasis with lower BSA: Week 16 results from the unveil study. J Drugs Dermatology. 2017;16(8):801–808.
  179. Gold LS, Bagel J, Lebwohl M, Mark Jackson J, Chen R, Goncalves J, et al. Efficacy and safety of apremilast in systemic- And biologic-naive patients with moderate plaque psoriasis: 52-week results of UnVEIL. J Drugs Dermatology. 2018;17(2):221–228.
  180. Reich K, Mrowietz U, Menter A, Griffiths CEM, Bagel J, Strober B, et al. Effect of baseline disease severity on achievement of treatment target with apremilast: results from a pooled analysis. J Eur Acad Dermatology Venereol. 2021;35(12):2409–2414.
  181. Reich K, Nestle FO, Papp K, Ortonne JP, Evans R, Guzzo C, et al. Infliximab induction and maintenance therapy for moderate-to-severe psoriasis: A phase III, multicentre, double-blind trial. Lancet. 2005;366(9494):1367–1374.
  182. Menter A, Feldman SR, Weinstein GD, Papp K, Evans R, Guzzo C, et al. A randomized comparison of continuous vs. intermittent infliximab maintenance regimens over 1 year in the treatment of moderate-to-severe plaque psoriasis. J Am Acad Dermatol. 2007;56(1):31.e1-31.e15.
  183. Shear NH, Hartmann M, Toledo-Bahena ME, Gilbert M, Katsambas A, Yao R, et al. Health-related quality-of-life improvements during 98 weeks of infliximab therapy in patients with plaque-type psoriasis in real-world practice. Qual Life Res. 2016;25(8):2031–2040.
  184. de Vries ACQ, Thio HB, de Kort WJA, Opmeer BC, van der Stok HM, de Jong EMGJ, et al. A prospective randomized controlled trial comparing infliximab and etanercept in patients with moderate-to-severe chronic plaque-type psoriasis: the Psoriasis Infliximab vs. Etanercept Comparison Evaluation (PIECE) study. Br J Dermatol. 2017;176(3):624–633.
  185. Papp KA, Tyring S, Lahfa M, Prinz J, Griffiths CEM, Nakanishi AM, et al. A global phase III randomized controlled trial of etanercept in psoriasis: Safety, efficacy, and effect of dose reduction. Br J Dermatol. 2005;152(6):1304–1312.
  186. Saurat JH, Stingl G, Dubertret L, Papp K, Langley RG, Ortonne JP, et al. Efficacy and safety results from the randomized controlled comparative study of adalimumab vs. methotrexate vs. placebo in patients with psoriasis (CHAMPION). Br J Dermatol. 2008;158(3):558–566.
  187. Menter A, Thaçi D, Papp KA, Wu JJ, Bereswill M, Teixeira HD, et al. Five-year analysis from the ESPRIT 10-year postmarketing surveillance registry of adalimumab treatment for moderate to severe psoriasis A portion of the data in this manuscript was presented in at the Fall European Academy of Dermatology and Venereology 2. J Am Acad Dermatol. 2015;73(3):410-419.e6.
  188. Gordon KB, Warren RB, Gottlieb AB, Blauvelt A, Thaçi D, Leonardi C, et al. Long-term efficacy of certolizumab pegol for the treatment of plaque psoriasis: 3-year results from two randomized phase III trials (CIMPASI-1 and CIMPASI-2). Br J Dermatol. 2021;184(4):652–662.
  189. Papp KA, Langley RG, Lebwohl M, Krueger GG, Szapary P, Yeilding N, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 52-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 2). Lancet. 2008;371(9625):1675–1684.
  190. Bone E, Delorefice C, Fishman L. New Phase 3 data demonstrate superiority of TREMFYA® (guselkumab) vs Cosentyx® (secukinumab) in delivering PASI 90 responses in the treatment of moderate to severe plaque psoriasis at week 48. 2018;(December). https://www.jnj.com/new-phase-3-data-demonstrate-superiority-of-tremfya-guselkumab-vs-cosentyx-secukinumab-in-delivering-pasi-90-responses-in-the-treatment-of-moderate-to-severe-plaque-psoriasis-at-week-48. Accessed 18 February 2021.
  191. Reich K, Armstrong AW, Foley P, Song M, Miller M, Shen YK, et al. Maintenance of Response Through up to 4 Years of Continuous Guselkumab Treatment of Psoriasis in the VOYAGE 2 Phase 3 Study. Am J Clin Dermatol. 2020;21(6):881–890.
  192. Reich K, Gordon KB, Strober BE, Armstrong AW, Miller M, Shen YK, et al. Five-year maintenance of clinical response and health-related quality of life improvements in patients with moderate-to-severe psoriasis treated with guselkumab: results from VOYAGE 1 and VOYAGE 2. Br J Dermatol. 2021;185(6):1146–1159.
  193. Blauvelt A, Gordon KB, Griffiths CEM, Papp KA, Foley P, Song M, et al. 28095 Long-term safety of guselkumab: Results from the VOYAGE 1 and VOYAGE 2 trials with up to 5 years of treatment. J Am Acad Dermatol. 2021;85(3):AB174.
  194. Thaçi D, Pinter A, Sebastian M, Termeer C, Sticherling M, Gerdes S, et al. Guselkumab is superior to fumaric acid esters in patients with moderate-to-severe plaque psoriasis who are naive to systemic treatment: results from a randomized, active-comparator-controlled phase IIIb trial (POLARIS). Br J Dermatol. 2020;183(2):265–275.
  195. Blauvelt A, Leonardi CL, Gooderham M, Papp KA, Philipp S, Wu JJ, et al. Efficacy and Safety of Continuous Risankizumab Therapy vs Treatment Withdrawal in Patients with Moderate to Severe Plaque Psoriasis: A Phase 3 Randomized Clinical Trial. JAMA Dermatology. 2020;156(6):649–658.
  196. Reich K, Gooderham M, Thaçi D, Crowley JJ, Ryan C, Krueger JG, et al. Risankizumab compared with adalimumab in patients with moderate-to-severe plaque psoriasis (IMMvent): a randomised, double-blind, active-comparator-controlled phase 3 trial. Lancet. 2019;394(10198):576–586.
  197. Langley RG, Elewski BE, Lebwohl M, Reich K, Griffiths CEM, Papp K, et al. Secukinumab in Plaque Psoriasis — Results of Two Phase 3 Trials. N Engl J Med. 2014;371(4):326–338.
  198. Blauvelt A, Prinz JC, Gottlieb AB, Kingo K, Sofen H, Ruer-Mulard M, et al. Secukinumab administration by pre-filled syringe: Efficacy, safety and usability results from a randomized controlled trial in psoriasis (FEATURE). Br J Dermatol. 2015;172(2):484–493.
  199. Paul C, Lacour JP, Tedremets L, Kreutzer K, Jazayeri S, Adams S, et al. Efficacy, safety and usability of secukinumab administration by autoinjector/pen in psoriasis: A randomized, controlled trial (JUNCTURE). J Eur Acad Dermatology Venereol. 2015;29(6):1082–1090.
  200. Gordon KB, Blauvelt A, Papp KA, Langley RG, Luger T, Ohtsuki M, et al. Phase 3 Trials of Ixekizumab in Moderate-to-Severe Plaque Psoriasis. N Engl J Med. 2016;375(4):345–356.
  201. Griffiths CEM, Reich K, Lebwohl M, Van De Kerkhof P, Paul C, Menter A, et al. Comparison of ixekizumab with etanercept or placebo in moderate-to-severe psoriasis (UNCOVER-2 and UNCOVER-3): Results from two phase 3 randomised trials. Lancet. 2015;386(9993):541–551.
  202. Paul C, Griffiths CEM, van de Kerkhof PCM, Puig L, Dutronc Y, Henneges C, et al. Ixekizumab provides superior efficacy compared with ustekinumab over 52 weeks of treatment: Results from IXORA-S, a phase 3 study. J Am Acad Dermatol. 2019;80(1):70-79.e3.
  203. Blauvelt A, Papp K, Gottlieb A, Jarell A, Reich K, Maari C, et al. A head-to-head comparison of ixekizumab vs. guselkumab in patients with moderate-to-severe plaque psoriasis: 12-week efficacy, safety and speed of response from a randomized, double-blinded trial. Br J Dermatol. 2020;182(6):1348–1358.
  204. Blauvelt A, Leonardi C, Elewski B, Crowley JJ, Guenther LC, Gooderham M, et al. A head-to-head comparison of ixekizumab vs. guselkumab in patients with moderate-to-severe plaque psoriasis: 24-week efficacy and safety results from a randomized, double-blinded trial. Br J Dermatol. 2021;184(6):1047–1058.
  205. Papp KA, Reich K, Paul C, Blauvelt A, Baran W, Bolduc C, et al. A prospective phase III, randomized, double-blind, placebo-controlled study of brodalumab in patients with moderate-to-severe plaque psoriasis. Br J Dermatol. 2016;175(2):273–286.
  206. Lebwohl M, Strober B, Menter A, Gordon K, Weglowska J, Puig L, et al. Phase 3 Studies Comparing Brodalumab with Ustekinumab in Psoriasis. N Engl J Med. 2015;373(14):1318–1328.

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