Recent Advancements in Antipsoriatic Therapy: An Update

Abstract

Psoriasis is a chronic inflammatory, a multisystem autoimmune disease with extreme pathological features and unsatisfied pharmacotherapeutic needs. Primarily psoriasis is associated with epidermal cells, keratinocyte hyperproliferation, inflammation, dermal capillary dilation, and proangiogenic mechanisms. Compared with other chronic diseases, patients with psoriasis have severe psychological stress and undergo reduced physical activeness, cognitive dysfunctions, and low-quality life. Pathophysiology is complex with the involvement of various mediators like interleukin-(IL)-17, IL-23, tumor necrosis factor-alpha (TNF-α), interferongamma(IFN-γ), and vascular endothelial growth factor (VEGF) that play a significant role in escalation and localizing the inflammation caused in psoriasis. However, acquiring uninterrupted knowledge of psoriasis pathophysiology allows us to identify the novel therapeutic targets that could be explored to overcome personalized psoriasis treatment challenges. Conventional therapy includes corticosteroids, vitamin-D, methotrexate, and cyclosporine, but with low efficacy and severe side effects and sometimes causing disease comorbidities. New biologics approved by FDA during 2016-2019, such as IL-23 blockers risankizumab-rza, guselkumab, and tildrakizumab-asmn, certolizumab pegol targeting TNF-α, IL-17 blockers brodalumab and ixekizumab have revolutionized the treatment of moderate to severe psoriasis due to targeted approach but are reported to possess many side effects leading to low patient compliance. Biosimilars of adalimumab, etanercept, and infliximab, designed by reverse engineering of biologics, are also becoming popular due to their cost-effectiveness. Drug repurposing focuses mainly on defining new medical uses for old drugs. The main focus of drug repurposing is how the drug molecule interacts with various targets and executes its pharmacological action, revealing the new possibilities of designing effective therapeutic agents with low toxicity.