Foreword: the value of biological therapies for psoriasis management
Authors: W. Sterry
Journal: British Journal of Dermatology (2004)

Advances in molecular research have furthered our understanding of the importance of the immune system in psoriasis pathogenesis. Such progress has allowed the development of a new class of therapies—biological therapies that are specifically targeted at key steps in the pathogenesis of psoriasis. In the U.S.A., three biological therapies, alefacept, efalizumab and etanercept have been approved by the Food and Drug Administration (FDA) for psoriasis and infliximab is in Phase III testing for psoriasis. A Marketing Authorization for the use of efalizumab in psoriasis therapy in Europe has been announced for the third quarter of 2004. There is a wide variety of therapies that are indicated for the management of plaque psoriasis. While effective, currently available systemic therapies are not ideal for all patients, due to a variety of reasons that may include long-term toxicity, drug–drug interactions, contraindications with concurrent illnesses or inconvenience. Furthermore, moderate to severe psoriasis can significantly reduce a patient's health-related quality of life (HRQOL), and many of the currently available therapies may contribute to this decline. Thus, there are several unmet medical needs for the safe, long-term management of patients with psoriasis. Biological therapies may address many of these unmet medical needs, representing a therapeutic advance. As biologicals represent a new approach to psoriasis management, there is not yet clear guidance on how to integrate these therapies into the psoriasis armamentarium. Given that there is great momentum in this area of research, it is likely that many more biologicals will be studied in patients with psoriasis, highlighting the importance of defining their value and their place alongside our current therapeutic options. A review of the literature and data recently presented at dermatology congresses indicates that, collectively, biologicals have been evaluated in thousands of patients with psoriasis. To date, the efficacy and safety data have been favourable. Furthermore, biologicals are associated with a significant improvement in various facets of HRQOL. Data indicate that biological therapies are an important addition to the available psoriasis treatments. While longer-term data in greater numbers of patients with psoriasis will be needed in order to characterize long-term safety profiles, the data available to date in patients with psoriasis, and the long-term data available for biologicals in other specialties (e.g. rheumatology or gastroenterology), suggest that long-term administration may allow for the safe, long-term control of psoriasis symptoms. This Supplement reflects the discussions and the consensus of a 1-day meeting held on 21 January 2004, in Zurich, Switzerland, with dermatologists from North and South America and Europe. The efficacy, safety and HRQOL-related issues pertaining to current systemic therapies and to biological therapies were discussed. Biological therapies were considered collectively during this meeting as a therapeutic class. Based on the data available to date, the group agreed that biological therapies, in addition to current systemic therapies and phototherapy, should be considered alongside current therapeutic options in patients with moderate to severe psoriasis. Biological therapies represent a significant advance based on our understanding of psoriasis pathophysiology, and provide dermatologists and patients with valuable new options for the management of this chronic disease.