Biological therapy
Biological therapies used to treat psoriasis target interleukin-17 (IL-17), interleukin-12 (IL-12), interleukin-23 (IL-23), and tumour necrosis factor alpha (TNFα)—see Biological therapies available in Australia for treatment of psoriasis, and their targets.
Response to biological therapy is often dramaticSbidian, 2021. As with other psoriasis treatments, the condition is likely to recur after stopping the drug, but some patients report long-term relief after stopping therapy. Some biological drugs also improve arthritis associated with psoriasis. General practitioners who suspect a patient will benefit from biological therapy (eg significant psychological distress, severe or extensive disease, disease on face, disease on hands or feet) should refer early for dermatologist advice.
|
Target |
Biological drugs |
|---|---|
|
IL-17 |
secukinumab ixekizumab |
|
both IL-12 and IL-23 |
ustekinumab |
|
IL-23 alone |
guselkumab tildrakizumab risankizumab |
|
TNFα |
adalimumab etanercept infliximab |
|
Note:
IL-12 = interleukin-12; IL-17 = interleukin-17; IL-23 = interleukin-23; TNFα = tumour necrosis factor alpha | |
Biological therapy may be subsidised by the PBS if specific criteria are met1.
Biological therapy is generally well tolerated; however, reactivating latent infection (particularly tuberculosis) and inducing malignancy are potential concerns. Treatment may need to be interrupted when a patient has a significant infection or malignancy—biological therapies targeting TNFα are of particular concern. Do not administer live vaccines in patients on biological therapy. For general considerations in biological therapy, including vaccinations, see Principles of immunomodulatory drug use in the Rheumatology guidelines.
Paradoxically, biological therapy (possibly being used to treat a concurrent condition) may trigger a flare of pustular psoriasis—this rarely occurs.