Abstract

Improved understanding of the pathophysiology of psoriasis has led to the development of biologic agents that offer improved safety and efficacy in the treatment of this disease. TNF inhibitors were the first biologics to be added to the therapeutic arsenal, and these were followed by agents that selectively block IL-12 and IL-23, two cytokines that play an important role in the immune cascade that leads to psoriasis. By targeting the p40 subunit shared by these cytokines, ustekinumab blocks the activity of IL 12/23, thereby reducing skin inflammation.The efficacy of ustekinumab has been analyzed in phase III clinical trials (PHOENIX 1 and 2) and its clinical development program was the largest ever for a biologic agent. Ustekinumab has also been compared to the TNF inhibitor etanercept in the first-ever head-to-head comparison of biologic agents in psoriasis (the ACCEPT psoriasis trial).

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