THE MANAGEMENT OF MODERATE TO SEVERE PSORIASIS: A BIOLOGIC REVOLUTION

Psoriasis is a chronic immune mediated skin disease affecting 1-2% of the UK population and has associated co-morbidities including Psoriatic Arthritis(PsA), metabolic syndrome and depression.^1,2 Psoriasis patients suffer from impaired quality of life due to social stigmatisation and often require lifelong treatment. Prior to the early 2000’s treatments available included phototherapy and conventional drug therapies including Methotrexate, Ciclosporin and Acitretin which are not without risk and require regular blood monitoring and outpatient dermatology review.

Since the introduction of anti-TNF drugs, the last 8 years has seen the introduction of a number of new biologic drugs targeting different pathways and receptors. Currently there are 6 biologic drugs licensed for treatment of psoriasis in the UK. These drugs have revolutionised patient care and the most recent anti IL-17 antagonists can now achieve a 90% reduction in the Psoriasis Area and Severity Index in up to 70% of patients. Concerns regarding safety of these drugs are largely unfounded and the British Association of Dermatology has initiated a registry to monitor these drugs (BADBIR) to measure long term safety data.

The main problems facing the modern dermatologist include treatment failures and patient expectations. Patients who have struggled for years using topical therapies and conventional systemic drugs, once clear or significantly improved on biologics often become intolerant to very limited clinical recurrence. Managing expectations relies heavily on the doctor patient relationship and patient education. Secondly, a small subset of patients initially respond but lose efficacy and can often move through biologic drugs quickly. These brittle patients ensure that our modern day struggle with Psoriasis is not over but their future remains bright with the introduction of novel biologic agents on the horizon.