J Korean Med Assoc.  2019 Mar;62(3):176-180. 10.5124/jkma.2019.62.3.176.

Recent medical therapy for psoriasis

Affiliations
  • 1Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. swyoun@snu.ac.kr

Abstract

Psoriasis is a chronic inflammatory disease. Medical therapy is the mainstay of the management of psoriasis, and the main target of psoriasis treatment is immunological dysregulation. Cyclosporine and methotrexate, the main conventional psoriasis treatments, usually lead to a Psoriasis Area and Severity Index (PASI) 75 response in 50% to 60% of patients, but show some organ toxicity. Biologics for psoriasis have recently become the main therapeutic agents for moderate to severe psoriasis unresponsive to conventional treatment. Tumor necrosis factor-α inhibitors were the first anti-psoriatic biologics to be developed, and also show good efficacy for psoriatic arthritis. Ustekinumab, the sole biologic designed for the inhibition of interleukin (IL)-12/23, has been most widely used for psoriasis in Korea. The main strength of ustekinumab is its relatively long treatment interval. IL-17 inhibitors have recently been introduced in Korea for psoriasis treatment. Secukinumab and ixekizumab are currently available IL-17 inhibitors that block the development of psoriasis lesions in the downstream events of psoriasis pathogenesis. They have excellent therapeutic efficacy, with a PASI 90 response in up to 60%-70% of patients. Selective IL-23 inhibitors have been more recently introduced in our country. They have an excellent PASI 90 response, and a longer injection interval than IL-17 inhibitors. New immunological modulators such as phosphodiesterase inhibitors, tyrosine kinase 2 inhibitors, and janus kinase inhibitors are planned to be introduced for psoriasis treatment. These are small molecules that can be administered orally, and some patients who are reluctant to receive injection therapy are expected to favor these therapeutic agents.

Keyword

Psoriasis; Severity of illness index; Tumor necrosis factor-alpha; Interleukin-17; Interleukin-23

MeSH Terms

Arthritis, Psoriatic
Biological Products
Cyclosporine
Humans
Interleukin-17
Interleukin-23
Interleukins
Korea
Methotrexate
Necrosis
Phosphodiesterase Inhibitors
Phosphotransferases
Psoriasis*
Severity of Illness Index
Tumor Necrosis Factor-alpha
TYK2 Kinase
Ustekinumab
Biological Products
Cyclosporine
Interleukin-17
Interleukin-23
Interleukins
Methotrexate
Phosphodiesterase Inhibitors
Phosphotransferases
TYK2 Kinase
Tumor Necrosis Factor-alpha
Ustekinumab

Reference

1. Song HJ, Park CJ, Kim TY, Choe YB, Lee SJ, Kim NI, Cho JW, Jeon JH, Jang MS, Youn JI, Kim MH, Park J, Kim KH, Kim BS, Youn SW, Lee JH, Lee MG, Ahn SK, Won YH, Yun SK, Shin BS, Seo SJ, Lee JY, Kim KJ, Ro YS, Kim Y, Yu DY, Choi JH. The clinical profile of patients with psoriasis in Korea: a Nationwide Cross-Sectional Study (EPI-PSODE). Ann Dermatol. 2017; 29:462–470.
Article
2. Choi JW, Kim BR, Seo E, Youn SW. Could psoriatic arthritis be easily diagnosed from current suspicious physical findings in the dermatology clinic? Ann Dermatol. 2017; 29:48–54.
Article
3. Youn SW, Kang SY, Kim SA, Park GY, Lee WW. Subclinical systemic and vascular inflammation detected by (18) F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with mild psoriasis. J Dermatol. 2015; 42:559–566.
Article
4. Boehncke WH, Schon MP. Psoriasis. Lancet. 2015; 386:983–994.
Article
5. Youn SW, Choi CW, Kim BR, Chae JB. Reduction of interrater and intra-rater variability in psoriasis area and severity index assessment by photographic training. Ann Dermatol. 2015; 27:557–562.
Article
6. Langley RG, Elewski BE, Lebwohl M, Reich K, Griffiths CE, Papp K, Puig L, Nakagawa H, Spelman L, Sigurgeirsson B, Rivas E, Tsai TF, Wasel N, Tyring S, Salko T, Hampele I, Notter M, Karpov A, Helou S, Papavassilis C. ERASURE Study Group. FIXTURE Study Group. Secukinumab in plaque psoriasis: results of two phase 3 trials. N Engl J Med. 2014; 371:326–338.
Article
7. Gordon KB, Blauvelt A, Papp KA, Langley RG, Luger T, Ohtsuki M, Reich K, Amato D, Ball SG, Braun DK, Cameron GS, Erickson J, Konrad RJ, Muram TM, Nickoloff BJ, Osuntokun OO, Secrest RJ, Zhao F, Mallbris L, Leonardi CL. UNCOVER-1 Study Group. UNCOVER-2 Study Group. UNCOVER-3 Study Group. Phase 3 trials of ixekizumab in moderate-to-severe plaque psoriasis. N Engl J Med. 2016; 375:345–356.
Article
8. Kim BR, Ohn J, Choi CW, Youn SW. Methotrexate in a real-world psoriasis treatment: is it really a dangerous medication for all? Ann Dermatol. 2017; 29:346–348.
Article
9. Kim BR, Yang S, Doh EJ, Choi CW, Youn SW. Risk factors affecting adverse effects of cyclosporine A in a real-world psoriasis treatment. Ann Dermatol. 2018; 30:143–149.
Article
10. Choi CW, Kim BR, Seo E, Youn SW. The objective Psoriasis Area and Severity Index: a randomized controlled pilot study comparing the effectiveness of ciclosporin and methotrexate. Br J Dermatol. 2017; 177:1740–1741.
Article
11. Choi CW, Kim BR, Ohn J, Youn SW. The advantage of cyclosporine A and methotrexate rotational therapy in long-term systemic treatment for chronic plaque psoriasis in a real world practice. Ann Dermatol. 2017; 29:55–60.
Article
12. Ahlehoff O, Skov L, Gislason G, Lindhardsen J, Kristensen SL, Iversen L, Lasthein S, Gniadecki R, Dam TN, Torp-Pedersen C, Hansen PR. Cardiovascular disease event rates in patients with severe psoriasis treated with systemic anti-inflammatory drugs: a Danish real-world cohort study. J Intern Med. 2013; 273:197–204.
Article
13. Youn SW. The use of biologics for severe psoriasis. J Korean Med Assoc. 2015; 58:917–922.
Article
14. Menter A, Tyring SK, Gordon K, Kimball AB, Leonardi CL, Langley RG, Strober BE, Kaul M, Gu Y, Okun M, Papp K. Adalimumab therapy for moderate to severe psoriasis: a randomized, controlled phase III trial. J Am Acad Dermatol. 2008; 58:106–115.
Article
15. Kulig P, Musiol S, Freiberger SN, Schreiner B, Gyülveszi G, Russo G, Pantelyushin S, Kishihara K, Alessandrini F, Kündig T, Sallusto F, Hofbauer GF, Haak S, Becher B. IL-12 protects from psoriasiform skin inflammation. Nat Commun. 2016; 7:13466.
Article
16. Leonardi CL, Kimball AB, Papp KA, Yeilding N, Guzzo C, Wang Y, Li S, Dooley LT, Gordon KB. PHOENIX 1 study investigators. 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; 371:1665–1674.
Article
17. Papp KA, Langley RG, Lebwohl M, Krueger GG, Szapary P, Yeilding N, Guzzo C, Hsu MC, Wang Y, Li S, Dooley LT, Reich K. PHOENIX 1 study investigators. 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; 371:1665–1674.
Article
18. Hwang YJ, Youn SW, Kim BR, Yu DY, Kim Y, Pires A, Cho S, Seo SJ, Lee ES, Roh JY, Choi GS, Lee MG. MARCOPOLO investigators. Clinical factors predicting the therapeutic response to ustekinumab in patients with moderate to severe chronic plaque psoriasis. J Dermatol. 2017; 44:560–566.
Article
Full Text Links
  • JKMA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr