Biologics for pityriasis rubra pilaris treatment: A review of the literature.

Pityriasis rubra pilaris (PRP) is a rare inflammatory papulosquamous skin disease that is often refractory to conventional therapies. The off-label use of biologics, such as anti-tumor necrosis factor, anti-interleukin (IL) 12/IL-23, and anti-IL-17 agents, has been proven successful in the past 2 decades for PRP treatment. Our aim was to analyse the literature for the use of biologics in PRP treatment. We conducted a review by performing PubMed and ClinicalTrials.gov searches. Sixty-eight articles met our selection criteria and are herein discussed. Out of 86 PRP patients, the vast majority were treated with anti-tumor necrosis factor, anti-IL-12/IL-23, or anti-IL-17 biologics, either alone or in combination therapy. A marked-to-complete response was observed in 50%-78%, a partial response in 11%-25%, and no or poor response in 11%-25%. This review has several limitations, including small sample sizes and the lack of shared study design criteria. In some instances, PRP might have resolved spontaneously. Further, the presence of concomitant therapy or the lack of detailed data on previous treatments, makes it difficult to strictly define a therapeutic role per se of specific biologics in PRP. This review shows that biologics may be regarded as a tool for PRP treatment alone or in combination therapy although clinical trials are needed to better assess their efficacy and safety.

Update on New and Emerging Therapies in the Management of Psoriasis.

Tumor necrosis factor inhibitors are a mainstay of treatment for patients with psoriasis who require systemic therapy. Since the approval of several of these agents, other biologic agents and small molecules have been developed; some of these have been approved recently by the US Food and Drug Administration, and others have shown great promise in clinical trials. The currently available and emerging treatments for psoriasis offer clinicians and patients an expanded list of options for individualizing treatment, potentially resulting in higher levels of improvement in both the disease process and quality of life. Semin Cutan Med Surg 34(supp2):S34-S36 © 2015 published by Frontline Medical Communications.

New and emerging therapies in psoriasis.

This article discusses the scientific rationale for the use of cytokine inhibitors, including ustekinumab, an inhibitor of the interleukin (IL)-12 and IL-23 pathways in psoriasis. Also addressed are the efficacy and safety data for this agent, as well as for several emerging therapies that target other cytokine pathways in psoriasis: the IL-17 inhibitors secukinumab, ixekizumab, and brodalumab, the IL-23 blocker tildrakizumab, and the small-molecule kinase inhibitors apremilast (a phosphodiesterase-4 blocker) and tofacitinib (a Janus kinase inhibitor).

Treatment of psoriatic arthritis with traditional DMARD's and novel therapies: approaches and recommendations.

INTRODUCTION: Recent advances in the therapeutics of psoriatic arthritis (PsA) have provided more options to clinicians managing PsA. The purpose of this review is to update the reader on treatment options for PsA using conventional synthetic disease modifying agents (csDMARDs) and novel therapies including tumour necrosis factor alpha inhibitors, interleukin 12/23 inhibitor (ustekinumab), the interleukin 17 antagonists including secukinumab, brodalumab, ixekizumab, and the phosphodiesterase-4 inhibitor, apremilast. Areas covered: We reviewed published articles on the treatment of PsA. Our main sources of data included treatment recommendations, registry studies, systematic literature reviews, major randomised controlled trials for more recently approved drugs, and abstracts from the American College of Rheumatology and EULAR meetings. Expert commentary: An overview of the evidence for the use of various pharmacotherapeutic agents for treatment of this heterogeneous disease was compiled. Treatment options for the various domains of PsA are also discussed.