Emerging Therapeutic Options in the Treatment of Moderate to Severe Plaque Psoriasis
Abstract
Psoriasis is a very common, chronic and recurrent, inflammatory systemic disease, which affects the skin and/or joints. It has several clinical variants, but plaque psoriasis is the most common and around 20% of patients have a moderate to severe form. With conventional treatment some patients experience an absence or loss of efficacy, side effects or inadequate response, so with the increasing knowledge on the pathophysiology of psoriasis, drugs with more specific targets have been developed in recent decades. The objective of this paper is to present new treatment options for moderate to severe plaque psoriasis in adults. A literature review was carried out on PubMed database and ClinicalTrials.gov for information on approved drugs, as well as on the results of clinical trials of emerging systemic therapies and currently in phase III. TNF-α inhibitors, a pioneering class of biologicals approved for psoriasis have been used successfully for several years. However, they also have limitations and, therefore, clinical research has been carried out focused on the search for new therapeutic targets. The discovery of participation of IL-23/ Th17 pathway in psoriasis oriented the development of novel immunomodulatory drugs, with encouraging results that validate the pro-inflammatory role of this pathway in the disease. Also, new orally available ‘small molecules’ are in development for the treatment of psoriasis. In practice, there isn’t a single most correct treatment for all patients with moderate to severe plaque psoriasis, in terms of efficacy, safety, dosing regimen and route of administration. Although new drugs have a long way to go before their approval, they represent a promise of more targeted, effective and safe treatment, with less interference with other biological functions and better control of the disease.
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