The TNF/IL‐23/IL‐17 axis—Head‐to‐head trials comparing different biologics in psoriasis treatment

• Published in: Scandinavian journal of immunology Vol. 92; no. 4; pp. e12946 - n/a
• Main Authors: ten Bergen, Lisa Lynn, Petrovic, Aleksandra, Krogh Aarebrot, Anders, Appel, Silke
• Format: Journal Article
• Language: English
• Published: Oxford Wiley Subscription Services, Inc 01.10.2020
• Subjects: Biological products; biologics; Cell differentiation; Cytokines; Drug development; head‐to‐head trials; Immunopathogenesis; Inflammation; Lymphocytes T; Oral administration; Psoriasis; Psoriasis vulgaris; TNF/IL‐23/IL‐17 axis; Tumor necrosis factor
• ISSN: 0300-9475; 1365-3083; 1365-3083
• DOI: 10.1111/sji.12946

Psoriasis is a T cell–mediated disease with autoimmune characteristics modulated by genetic susceptibility along with environmental triggers. Inflammatory pathways marked with excessive production of cytokines IL‐12 and IL‐23, drive differentiation of pathogenic T cell responses resulting in TNF and IL‐17 production. These cytokines are an integral part of the TNF/IL‐23/IL‐17 axis, which is responsible for maintaining inflammation in psoriatic skin. Our improved understanding of the immunopathogenesis led to the development of biological drugs in the treatment of moderate‐to‐severe disease. Biologics have revolutionized the management of psoriasis, highlighting the central role of TNF/IL‐23/IL‐17 axis in the physiopathology of the disease. Still, psoriasis usually requires long‐term treatment, aiming to fully remove psoriatic lesions without experiencing adverse events. In this review, we discuss the recent findings of all 27 available head‐to‐head trials investigating the efficacy and safety of systemic and biologic therapies in moderate‐to‐severe psoriasis vulgaris, as it is thought to provide more useful knowledge than placebo intervention alone. According to our evaluation, inhibitors that specifically target IL‐23 or IL‐17 are clinically more beneficial than inhibitors of IL‐12/IL‐23 and TNF. More informative results might be obtained by comparing these more efficient biological agents to each other. In addition, newer therapies for psoriasis using small‐molecule drugs may represent important advances compared to well‐established biologics as these are less expensive and orally administered.